title: Feeding infants below 29 weeks' gestation with abnormal antenatal Doppler: analysis from a randomised trial.
abstract: OBJECTIVE
  To describe feeding and gastrointestinal outcomes in growth-restricted infants <29 weeks' gestation and to determine the rate of feed advancement which they tolerate.
  
  
  METHODS
  Analysis of prospectively collected data from a randomised feeding trial, the Abnormal Doppler Enteral Prescription Trial (ADEPT).
  
  
  METHODS
  54 neonatal units in the UK and Ireland.
  
  
  METHODS
  404 preterm, growth-restricted infants with abnormal antenatal Doppler studies from ADEPT. 83 infants <29 weeks and 312 infants ≥ 29 weeks' gestation were included in this analysis.
  
  
  METHODS
  In ADEPT, infants were randomised to start milk 'early' on day 2 after birth, or 'late' on day 6. Subsequent feed advancement followed a regimen, which should have achieved full feeds by day 16 in the early and day 20 in the late group.
  
  
  METHODS
  Full feeds were achieved later in infants <29 weeks; median age 28 days {IQR 22-40} compared with 19 days {IQR 17-23} in infants ≥ 29 weeks (HR 0.35, 95% CI 0.3 to 0.5). The incidence of necrotising enterocolitis was also higher in this group; 32/83 (39%) compared to 32/312 (10%) in those ≥ 29 weeks (RR 3.7, 95% CI 2.4 to 5.7). Infants <29 weeks tolerated very little milk for the first 10 days of life and reached full feeds 9 days later than predicted from the trial regimen.
  
  
  CONCLUSIONS
  Growth-restricted infants born <29 weeks' gestation with abnormal antenatal Doppler failed to tolerate even the careful feeding regimen of ADEPT. A slower advancement of feeds may be required for these infants.
  
  
  BACKGROUND
  ISRCTN87351483.
authors: Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, , London, UK.
authors: Stephen
authors: S
authors: Kempley
authors: Neelam
authors: N
authors: Gupta
authors: Louise
authors: L
authors: Linsell
authors: Jon
authors: J
authors: Dorling
authors: Kenny
authors: K
authors: McCormick
authors: Paul
authors: P
authors: Mannix
authors: Edmund
authors: E
authors: Juszczak
authors: Peter
authors: P
authors: Brocklehurst
authors: Alison
authors: A
authors: Leaf
mesh_terms: D000818:Animals; D001942:Breast Feeding; D004750:Enteral Nutrition / Q000009:adverse effects* / Q000379:methods; D020345:Enterocolitis, Necrotizing / Q000209:etiology*; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000628:therapy*; D005865:Gestational Age; D006801:Humans; D041943:Infant Formula / Q000008:administration & dosage*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D019102:Infant, Very Low Birth Weight; D007494:Ireland; D008297:Male; D011247:Pregnancy; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal; D006113:United Kingdom
keywords: Fetal Medicine; Gastroenterology; Neonatology; Nutrition