Early Total Versus Gradually Advanced Enteral Nutrition in Stable Very-Low-Birth-Weight Preterm Neonates: A Randomized, Controlled Trial.

Abstract

To assess whether early total enteral nutrition (80mL/kg/d) started on day 1 of life in hemodynamically stable preterm very-low-birth-weight (VLBW) neonates with the rapid advancement of feeds (20mL/kg/d) help in the earlier achievement of full feeds (180mL/kg/d). Early total enteral nutrition (intervention) group feeding was started with 80mL/kg/d on the first day in all hemodynamically stable neonates admitted with birth weight of 1000-1499grams, born at 29-33 wk of gestation as determined by first-trimester ultrasonography (USG) or expanded New Ballard Score (NBS) and was advanced by 20mL/kg/d until maximum feeds of 180mL/kg/d were achieved; while in control group feeding was started with 30mL/kg/d on the first day and was advanced by 20mL/kg/d until maximum feeds were achieved. Primary outcome measure was time taken to achieve full feeds; secondary outcomes were duration of hospital stay, necrotizing enterocolitis (NEC), time to regain birth weight, duration of antibiotics, and death. Sixty VLBW neonates (1000-1499g) with comparable baseline demographics were randomized within 24h of admission to two groups. Early total enteral nutrition intervention group (group I, n= 31) achieved the target of full enteral nutrition at median 6 d; IQR: 0 to 7.8 d, a significantly shorter time compared to the controls (n= 29) (median 10 d; IQR: 9 to 11.0 d; p= < 0.05). Early total enteral nutrition started from the first day of life results in significantly less time to achieve full feeds in hemodynamically stable preterm and VLBW infants.