Prolonging Small Feeding Volumes Early in Life Decreases the Incidence of Necrotizing Enterocolitis in Very Low Birth Weight Infants
- 1 March 2003
- journal article
- clinical trial
- Published by American Academy of Pediatrics (AAP) in Pediatrics
- Vol. 111 (3), 529-534
- https://doi.org/10.1542/peds.111.3.529
Abstract
Objective. Approximately 90% of infants who develop necrotizing enterocolitis (NEC) do so after being fed. Previous prospective studies have shown that infants given small enteral feedings for the first 7 to 10 days of feeding do not have an increased risk for NEC compared with those given no feedings. Although neonatologists now commonly increase feeding volumes, no study has compared the risk for NEC between infants fed these small volumes and those fed volumes that are increased slowly. The purpose of this study was to compare the risks and benefits of small and increasing feeding volume. Methods. In a randomized, controlled trial, we randomly assigned 141 preterm infants in the newborn intensive care unit to be fed 10 days using 1 of 2 schedules. One group was fed 20 mL/kg/d for the first 10 study days (minimal). The other group (advancing) was fed 20 mL/kg/d on study day 1; feeding volume was increased by 20 mL/kg/d up to 140 mL/kg/d, which was maintained until study day 10. The main outcome measure was incidence of NEC; secondary outcomes were maturation of intestinal motor patterns, time to reach full enteral feedings, and incidence of late sepsis. Results. The study was closed early because 7 infants who were assigned to advancing feeding volumes developed NEC, whereas only 1 infant fed minimal feeding volumes did, or 10% versus 1.4%. Although infants who were fed minimal volumes established full enteral feeding volumes later than infants who were fed advancing volumes, maturation of intestinal motor patterns and the incidence of late sepsis and feeding intolerance was similar in the 2 groups. Conclusion. Given that advancing feeding volumes increase the risk of NEC without providing benefits for motor function or feeding tolerance, neonatologists should consider using minimal feeding volumes until future trials assess the safety of advancing feeding volumes.Keywords
This publication has 25 references indexed in Scilit:
- Randomized trial of “slow” versus “fast” feed advancements on the incidence of necrotizing enterocolitis in very low birth weight infantsThe Journal of Pediatrics, 1999
- Late-onset sepsis in very low birth weight neonates: A report from the National Institute of Child Health and Human Development Neonatal Research NetworkThe Journal of Pediatrics, 1996
- Gastrin, Motilin, Insulin, and Insulin‐Like Growth Factor‐I Concentrations in Very‐Low‐Birth‐Weight Infants Receiving Enteral or Parenteral NutritionJournal of Parenteral and Enteral Nutrition, 1993
- Role of delayed feeding and of feeding increments in necrotizing enterocolitisThe Journal of Pediatrics, 1992
- Gastrointestinal Priming Prior to Full Enteral Nutrition in Very Low Birth Weight InfantsJournal of Pediatric Gastroenterology and Nutrition, 1992
- Effect of early feeding on maturation of the preterm infant's small intestineThe Journal of Pediatrics, 1992
- Neonatal small intestinal motility: Motor responses to feeding in term and preterm infantsThe Journal of Pediatrics, 1990
- Postnatal Maturation of Small Intestinal Motility in Preterm and Term InfantsNeurogastroenterology & Motility, 1989
- Effect of early low-volume enteral substrate on subsequent feeding tolerance in very low birth weight infantsThe Journal of Pediatrics, 1988
- Beneficial effects of early hypocaloric enteral feeding on neonatal gastrointesting function: Preliminary report of a randomized trialThe Journal of Pediatrics, 1988