Abstract
Objective:To determine the outcomes in very low birth weight (VLBW) neonates receiving volume advancement versus frequency advancement feeding protocols.Methods:This controlled clinical trial was conducted in Children Hospital Multan within duration of 6 months from February 2017 to August 2017. VLBW neonates having weight < 1500 g at the time of birth were included. The protocol for frequency advancement (FA) group was to give 1 ml/kg human or pre-formula milk after every 8 hours and in volume advancement (VA) group after every 3 hours initially. After three days, in FA group duration of feeds was decreased gradually from 8 to 2 hours and feed volume of 10 ml.kg-1.day-1 until full-recommended dose of feeding i.e. 150 ml.kg-1.day-1 reached. While in VA group, volume of 20 ml.kg-1.day-1 was given until full-recommended dose of feeding reached. Days to achieve full feed, weight gain, and length of hospital stay were primary study outcomes.Results:Baseline weight of neonates was 1148 (111) grams in VA 1179 (106) grams in FA groups (p-value 0.18). In VA group, full feed was achieved in 11.04 (2.38) days versus 15.76 (2.48) days in FA group (P-value <0.001). Duration of IV fluid therapy were 13.5 (8.4) days in FA group versus 9.4 (7.6) in VA group (p-value <0.001). Moreover weight gain at the end of feeding protocol was significantly higher in VA group 1440 (78) grams versus 1284 (99) grams in FA group (P-value <0.001). Necrotizing entero-colitis occurred in only one neonate that was belonging to volume advancement group.Conclusion:Volume advancement (VA) feeding is better as compared to frequency advancement (FA) feeding in very low birth weight neonates.
Highlights
Advancements in practice and experience of neonatologists have greatly reduced the death rate of premature neonates born with very low birth weight (VLBW)
Mean gestational age of neonates was almost same in volume advancement (VA) and frequency advancement (FA) groups
APGAR score after 5 minutes of birth was 8.31 (0.98) in VA group and 8.32 (0.96) in FA group (p-value 0.96)
Summary
Advancements in practice and experience of neonatologists have greatly reduced the death rate of premature neonates born with very low birth weight (VLBW). Some studies have suggested that a higher amount of breast milk (> 200 ml/kg/day) as compared to the normal dose (150 ml/kg/day) of breast milk is needed in these infants but others say that there is no need for extra dose.[14,15] There are two recommended methods of starting the feeding in these infants, one method is that to start feeding earlier and increase the feeding volumes rapidly to achieve recommended daily dose and the other is increasing the frequency of feeds rather than increasing the volume of feeds Both of these protocols have some advantages and disadvantages. We compared the volume versus frequency bases protocols of feeding in VLBW neonates in a tertiary care neonatal care facility
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