Effect of early feeding regimen in pre-terms with abnormal antenatal dopplers: a prospective analytical COHORT study

Abstract

Background: Enteral feeding in preterm neonates with intrauterine growth restriction (IUGR) and absent or reversed end diastolic flow (AREDF) on umbilical artery (UA) Doppler is delayed owing to an increased risk of necrotizing enterocolitis (NEC). Delaying enteral feeding with longer duration of parenteral nutrition (PN) carries an increased risk of various neonatal morbidities.Methods: It was a prospective observational non randomized cohort study. Data was collected prospectively from the NICU records. Neonates fulfilling the inclusion criteria were classified as early feeding regimen and late feeding regimen. A strict feeding regimen was followed. Data was analyzed for primary and secondary outcomes.Results: The 50 neonates were enrolled. Baseline characteristics were comparable. A significantly higher time to full feeds was recorded in the delayed feeding regimen by a mean of 3.9 days. The duration of hospital stay was significantly higher for delayed feeding regimen (+12.7 days). Days of mechanical ventilation were also significantly higher (+1.6 days) in the neonates in delayed feeding group. There was no difference in the incidence of feed intolerance, NEC, incidence of culture positive sepsis and mortality across the two regimens, however neonates in the delayed feeding group needed longer support with parenteral nutrition.Conclusions: Early feeding will lead to earlier time to full feeds and decreased duration of hospital stay without additional increase the incidence of feeding intolerance and NEC in neonates with AEDF/REDF. Individualized feeding strategy in these compromised neonates should be the primary objective to optimize outcomes.