Feeding infants below 29 weeks' gestation with abnormal antenatal Doppler: Analysis from a randomised trial

Kempley, Stephen, Gupta, Neelam, Linsell, Louise, Dorling, Jon, McCormick, Kenny, Mannix, Paul, Juszczak, Edmund, Brocklehurst, Peter and Leaf, Alison (2014) Feeding infants below 29 weeks' gestation with abnormal antenatal Doppler: Analysis from a randomised trial. Archives of Disease in Childhood: Fetal and Neonatal Edition, 99 (1), F6-F11. (doi:10.1136/archdischild-2013-304393).

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. Design: Analysis of prospectively collected data from a randomised feeding trial, the Abnormal Doppler Enteral Prescription Trial (ADEPT). Setting: 54 neonatal units in the UK and Ireland. Participants: 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. Interventions: 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. Main outcome measures: 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. Trial registration number: ISRCTN87351483.

This record has no associated files available for download.

Contributors

Author: Jon Dorling

Download statistics