Early enteral feeding in preterm infants
File(s)
Author(s)
Kwok, T'ng Chang
Dorling, Jon
Gale, Chris
Type
Journal Article
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.
Date Issued
2019-11-01
Date Acceptance
2019-07-01
Citation
Seminars in Perinatology, 2019, 43 (7), pp.1-11
ISSN
0146-0005
Publisher
Elsevier
Start Page
1
End Page
11
Journal / Book Title
Seminars in Perinatology
Volume
43
Issue
7
Copyright Statement
© 2019 Elsevier Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000492487900008&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Obstetrics & Gynecology
Pediatrics
Enteral feeds
Infant
Premature
Infant nutritional physiological phenomena
Necrotising enterocolitis
Small for gestational age
Review
BIRTH-WEIGHT INFANTS
RANDOMIZED CONTROLLED-TRIAL
NECROTIZING ENTEROCOLITIS
PREMATURE-INFANTS
ACCELERATED ADVANCEMENT
HISTORIC COHORT
MOTOR-ACTIVITY
MILK FEEDS
GROWTH
SLOW
Publication Status
Published
Article Number
UNSP 151159
Date Publish Online
2019-07-24