Submitted to: Pediatrics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: July 8, 1998
Publication Date: N/A
Interpretive Summary: There is no consensus on the best strategy to use when feeding the premature infant, who cannot suck and must be given milk through a tube. We set up a study to evaluate common strategies for feeding premature infants. We tested two tube-feeding methods, either continuous flow or intermittent feeding every 3 hours. We also tested how early milk can be started, either on day 4 after birth in a small volume to "prime" the intestinal tract or at the standard time of 15 days. Little is known about how these strategies might speed or slow the time required for the infant to fully feed the regular way by mouth, which may affect the length of time the baby remains hospitalized, its growth rate, absorption of nutrients, bone mineral formation, and feeding tolerance. Our study groups evaluated the impact of these factors. The length of time required for infants to fully and independently feed themselves by mouth was similar among groups. The early feeding group (day 4) had less need of umbilical artery catheters an insulin therapy, faster digestion, and achieved the first successful oral feeding sooner than the standard (day 15) group. The standard group had much lower absorption and retention of key minerals. The continuous feeding group had more trouble with feeding tolerance than the intermittently fed group. Our findings suggest that early initiation of feeding, using the intermittent tube-feeding method, may be best for premature infants.
Technical Abstract: Data on enteral feeding management of premature infants are limited. Several small studies suggest benefits from the early initiation of feeding, but do not assess potential interactions among feeding method, type of milk used, and time of initiation of feeding. These factors, as well as their interactions, may affect the time required to attain independent oral feeding, duration of hospitalization, rates of growth, nutrient absorption, bone mineralization, biochemical measures of nutritional status, and feeding tolerance. A total of 171 premature infants, stratified by gestational age (26 to 30 wk) and diet (mother's milk or preterm formula) were assigned randomly among four treatment combinations in a balanced two-way design where the two factors were the time of initiation of feeding (early, 4 d vs standard, 15 d) and the method of tube-feeding (continuous infusion vs intermittent). Results: The number of medical dropouts and the distribution of morbidities were similar for each treatment. The time required for infants to attain independent oral feeding was similar among groups. Early feeding was associated with less need for umbilical artery catheters and exogenous insulin therapy, more rapid gastrointestinal transit, and sooner transition to oral feeding than standard initiation of feeding. Early feeding also was associated with markedly greater absorption and retention of calcium, phosphorus, and copper than standard feeding. The intermittent method was associated with significantly fewer protocol violators and less feeding intolerance but no differences in growth or nutrient absorption compared with the continuous method. Early initiation of enteral feeding, using the intermittent method, may provide the greatest advantage for the premature infant.