Early enteral feeding in preterm infants
Early enteral feeding in preterm infants
Early enteral feeding is a potentially modifiable risk factor for necrotising enterocolitis (NEC) and late onset sepsis (LOS), however enteral feeding practices for preterm infants are highly variable. High-quality evidence is increasingly available to guide early feeding in preterm infants. Meta-analyses of randomised trials indicate that early trophic feeding within 48 h after birth and introduction of progressive enteral feeding before 4 days of life at an advancement rate above 24 ml/kg/day can be achieved in clinically stable very preterm and very low birthweight (VLBW) infants, without higher mortality or incidence of NEC. This finding may not be generalisable to high risk infants such as those born small for gestational age (SGA) or following absent/reversed end diastolic flow velocity (AREDFV) detected antenatally on placental Doppler studies, due to the small number of such infants in existing trials. Trials targeting such high-risk preterm infants have demonstrated that progressive enteral feeding started in the first 4 days is safe and does not lead to higher NEC or mortality; however, there is a paucity of data to guide feeding advancement in such infants. There is little trial evidence to support bolus or continuous gavage feeding as being superior in clinically stable preterm infants. Trials that examine enteral feeding are commonly unblinded for technical and practical reasons, which increases the risk of bias in such trials, specifically when considering potentially subjective outcome such as NEC and LOS; future clinical trials should focus on objective, primary outcome measures such as all-cause mortality, long term growth and neurodevelopment. Alternatively, important short-term outcomes such as NEC could be used with blinded assessment.
Enteral feeds, Infant, Infant nutritional physiological phenomena, Necrotising enterocolitis, Premature, Review, Small for gestational age
Kwok, T'ng Chang
b16d4a0d-3149-46cc-b028-86fa6caf3ea9
Dorling, Jon
e55dcb9a-a798-41a1-8753-9e9ff8aab630
Gale, Chris
210b7c81-9a39-460a-9ab3-54fe92a69f8e
12 October 2019
Kwok, T'ng Chang
b16d4a0d-3149-46cc-b028-86fa6caf3ea9
Dorling, Jon
e55dcb9a-a798-41a1-8753-9e9ff8aab630
Gale, Chris
210b7c81-9a39-460a-9ab3-54fe92a69f8e
Kwok, T'ng Chang, Dorling, Jon and Gale, Chris
(2019)
Early enteral feeding in preterm infants.
Seminars in Perinatology, 43 (7), [151159].
(doi:10.1053/j.semperi.2019.06.007).
Abstract
Early enteral feeding is a potentially modifiable risk factor for necrotising enterocolitis (NEC) and late onset sepsis (LOS), however enteral feeding practices for preterm infants are highly variable. High-quality evidence is increasingly available to guide early feeding in preterm infants. Meta-analyses of randomised trials indicate that early trophic feeding within 48 h after birth and introduction of progressive enteral feeding before 4 days of life at an advancement rate above 24 ml/kg/day can be achieved in clinically stable very preterm and very low birthweight (VLBW) infants, without higher mortality or incidence of NEC. This finding may not be generalisable to high risk infants such as those born small for gestational age (SGA) or following absent/reversed end diastolic flow velocity (AREDFV) detected antenatally on placental Doppler studies, due to the small number of such infants in existing trials. Trials targeting such high-risk preterm infants have demonstrated that progressive enteral feeding started in the first 4 days is safe and does not lead to higher NEC or mortality; however, there is a paucity of data to guide feeding advancement in such infants. There is little trial evidence to support bolus or continuous gavage feeding as being superior in clinically stable preterm infants. Trials that examine enteral feeding are commonly unblinded for technical and practical reasons, which increases the risk of bias in such trials, specifically when considering potentially subjective outcome such as NEC and LOS; future clinical trials should focus on objective, primary outcome measures such as all-cause mortality, long term growth and neurodevelopment. Alternatively, important short-term outcomes such as NEC could be used with blinded assessment.
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e-pub ahead of print date: 24 July 2019
Published date: 12 October 2019
Additional Information:
Funding Information:
CG is funded by the United Kingdom Medical Research Council (MRC) through a Clinician Scientist Fellowship award. He has received support from Chiesi Pharmaceuticals to attend an educational conference; in the past 5 years he been investigator on received research grants from Medical Research Council, National Institute of Health Research, Canadian Institute of Health Research, Department of Health in England, Mason Medical Research Foundation, Westminster Medical School Research Trust and Chiesi Pharmaceuticals. JD is the chief investigator for the Speed of Increasing milk Feeds Trial (SIFT) funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (Grant number 11/01/25). He is also the recipient of NIHR funding for other studies as a co-investigator and has received salary support through his previous employer to work as a clinical expert on a clinical trial by Nutrinia.
Keywords:
Enteral feeds, Infant, Infant nutritional physiological phenomena, Necrotising enterocolitis, Premature, Review, Small for gestational age
Identifiers
Local EPrints ID: 485080
URI: http://eprints.soton.ac.uk/id/eprint/485080
ISSN: 0146-0005
PURE UUID: 4a3a7ad9-d3c2-40b0-bf9f-9b007b1a98a1
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Date deposited: 29 Nov 2023 17:32
Last modified: 18 Mar 2024 04:16
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Author:
T'ng Chang Kwok
Author:
Jon Dorling
Author:
Chris Gale
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