Prolonged Minimal Enteral Nutrition Versus Slowly Advancing Enteral Nutrition in Very Low Birth Weight Infants:
Condition: Enteral Nutrition; Born Very Premature; Infant, Very Low Birth Weight
MeSH terms: Birth Weight
Study type: Interventional

Summary: 
      Recent studies showed the benefits of early initiation and advancement enteral feeds with
      daily increments in preterm infants on decreasing invasive infections and early achievement
      of full enteral feedings. But the data on enteral feeds of extremely low birthweight infants
      are limited. Preterm infants especially those <1250 gr birthweight are at increased risk of
      developing feeding intolerance and necrotizing enterocolitis (NEC) and so the initiation and
      the rate of increments of enteral feeds are usually uncertain issues for neonatologists.
    

Detailed description: 
      Background: Recent studies showed the benefits of early initiation and advancement enteral
      feeds with daily increments in preterm infants on decreasing invasive infections and early
      achievement of full enteral feedings. But the data on enteral feeds of extremely low
      birthweight infants are limited. Preterm infants especially those <1250 gr birthweight are at
      increased risk of developing feeding intolerance and necrotizing enterocolitis and so the
      initiation and the rate of increments of enteral feeds are usually uncertain issues for
      neonatologists.

      Aim: To assess the effects of two different feeding strategies in very low birth weight
      preterm infants with birth weight ≤1250 gr and gestational age ≤32 weeks on the incidence of
      feeding intolerance and time to reach full enteral feedings.

      Study design: prospective randomized controlled trial comparing the effects of prolonged
      minimal enteral nutrition (MEN) with progressive advancing enteral feedings.

      Primary outcomes: incidence of feeding intolerance and time to reach full enteral feedings
      sustained for 72 hours.

      Secondary outcomes: incidence of NEC, sepsis, duration of hospitalization Methods: a total of
      200 preterm infants with gestational age ≤32 weeks and birthweight ≤1250 gr were randomly
      allocated to one of the 2 feeding strategies.

      Group 1-) Feeding was started in the first 48 hours. Fed with 10-15 ml/kg/d MEN for 5 days
      and than feed volumes were advanced by 20-25 ml/kg/d until 150ml/kg/d feed volume was
      achieved.

      Group 2-) Feeding was started in the first 48 hours with a volume of 10-15 ml/kg/d and
      advanced with daily increments of 20-25 ml/kg/d until 150 ml/kg/d feed volume was achieved.

      MEN was withheld when the infant developped NEC or when there was bilious emesis or gross
      blood in stool.

      Feeding intolerance was defined as; Bilious emesis or gastric residuals Grossly bloody
      stools, Abdominal tenderness or discoloration, Gastric residuals in ≥%50 of previous feed
      volume Emesis ≥3 times in 8 hours period Clinical or radiological evidence of NEC When
      feeding intolerance was developped feeds were withheld in both groups until the problem was
      resolved and resumed feed volume where withheld.

      In the study unit parenteral nutrition was started on the first day of birth. Parenteral
      nutrition volume was decreased as the enteral feeds increased. Breast milk was the first
      choice for enteral nutrition if available but if not preterm formulas were used. When
      100ml/kg/d enteral feed volume was achieved breast milk was fortified with Euprotin as a
      standard procedure.
    

Intervention name(s): nutrition
Intervention type(s): Dietary Supplement
Intervention description(s): Feeding was started in the first 48 hours. Fed with 10-15 ml/kg/d MEN for 5 days and than feed volumes were advanced by 20-25 ml/kg/d until 150ml/kg/d feed volume was achieved.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: feeding intolerance; minimal enteral nutrition; very low birth weight; preterm infant