Impact of a new aggressive nutrition policy incorporating early introduction of parenteral nutrition and mother's own milk on growth of preterm infants.
BACKGROUND
Most of the evidence on early feeding of preterm infants was derived from high income settings, it is equally important to evaluate whether it can be successfully implemented into less resourced settings. This study aimed to compare growth and feeding of preterm infants before and after the introduction of a new aggressive feeding policy in Penang Hospital, a tertiary referral hospital in a middle income country.


METHODS
The new aggressive feeding policy was developed mainly from Cochrane review evidence, using early parenteral and enteral nutrition with standardized breastfeeding counselling aimed at empowering mothers to provide early expressed milk. A total of 80 preterm babies (34 weeks and below) discharged from NICU were included (40 pre- and 40 post-intervention). Pre and post-intervention data were compared. The primary outcome was growth at day 7, 14, 21 and at discharge and secondary outcomes were time to full oral feeding, breastfeeding rates, and adverse events.


RESULTS
Complete data were available for all babies to discharge. One baby was discharged prior to day 14 and 10 babies before day 21, so growth data for these babies were unavailable. Baseline data were similar in the two groups. There was no significant weight difference at 7, 14, 21 days and at discharge. More post-intervention babies were breastfed at discharge than pre-intervention babies (21 vs. 8, P=0.005). Nosocomial infection (11 vs. 4, P=0.045), and blood transfusion were significantly lower in the postintervention babies than in the pre-intervention babies (31 vs. 13, P=0.01). The post-intervention babies were more likely to achieve shorter median days (interquartile range) to full oral feeding [11 (6) days vs. 13 (11) days, P=0.058] and with lower number affecting necrotising enterocolitis (0 vs. 5, P=0.055).


CONCLUSIONS
Early aggressive parenteral nutrition and early provision of mother's milk did not result in improved growth as evidenced by weight gain at discharge. However we found more breastfeeding babies, lower nosocomial infection and transfusion rates. Our findings suggest that implementing a more aggressive feeding policy supported by high level scientific evidence is able to improve important outcomes.
Penang Medical College, Penang, 10450, Malaysia. Eugenelcs33@hotmail.com.
Chuen Siang
CS
Low
Department of Pediatrics, Penang Medical College, Penang, Malaysia.
Jacqueline J
JJ
Ho
Department of Pediatrics, Penang Hospital, Penang, Malaysia.
Revathy
R
Nallusamy
D001942:Breast Feeding / Q000639:trends*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay; D008296:Malaysia; D008297:Male; D018673:Nutrition Policy; D017063:Outcome Assessment, Health Care; D010288:Parenteral Nutrition / Q000592:standards* / Q000639:trends; D010351:Patient Discharge; D011050:Policy Making; D011247:Pregnancy; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D062606:Tertiary Care Centers
early breastfeeding; early parenteral nutrition; pediatrics; preterm babies