Rapid Enteral Feeding Research Articles

Clinical Outcomes of Slow versus Rapid Enteral Feeding Advancement in Very Low Birth Weight Neonates at a Tertiary Care Center

In India, every year around 3.5 million babies are born premature, accounting for almost 13% of total livebirths in the country as compared to 5% to 7% incidence in the West. Preterm is defined as babies born before 37 weeks ofpregnancy. The rapidity of feed volume increments involves controversies like faster weight gain, shorter hospital stays, therisk of necrotizing enterocolitis and vice versa. Methods: The present study was a randomized controlled trial conducted fromJune 1, 2018 to October 31, 2019. All infants in the study were randomized to slow and rapid feeding protocols by a stratifiedblock randomization sequence of 2, 4, 6 blocks. Group 1 or the slow advancement group included 64 newborns babies andGroup 2 or the rapid advancement group included 69 newborns babies. Results: The average weight gain in Group 1 was4.41 ± 0.9 g and in Group 2 it was 6.33 ± 1.3 g, the difference was statistically significant (p < 0.02). Sixty out of 64 newbornsregained birth weight within 16.87 ± 0.9 days in Group 1, while 64 out of 69 newborns regained birth weight within 13.63 ±0.9 days in Group 2. The difference was statistically significant. Increment in the mean occipitofrontal circumference perweek was 0.29 ± 0.27 cm Group 1, while in Group 2 it was 0.42 ± 0.05 cm; the difference was statistically significant. Meanaverage length increment per week was found to be 0.55 ± 0.04 cm and 0.69 ± 0.05 cm in Group 1 and Group 2, respectively,the difference was statistically significant (p < 0.005). The mean duration of hospital stay was 27.47 ± 3.33 days in Group 1while in Group 2, the duration of stay was 23.15 ± 2.22 days, the difference was statistically significant. Conclusion: Ourstudy supports enteral nutrition by rapid enteral feeding regimen in stable preterm neonates with very low birth weight

Clinical Outcomes of Slow versus Rapid Enteral Feeding Advancement in Very Low Birth Weight Neonates at a Tertiary Care Center

In India, every year around 3.5 million babies are born premature, accounting for almost 13% of total livebirths in the country as compared to 5% to 7% incidence in the West. Preterm is defined as babies born before 37 weeks ofpregnancy. The rapidity of feed volume increments involves controversies like faster weight gain, shorter hospital stays, therisk of necrotizing enterocolitis and vice versa. Methods: The present study was a randomized controlled trial conducted fromJune 1, 2018 to October 31, 2019. All infants in the study were randomized to slow and rapid feeding protocols by a stratifiedblock randomization sequence of 2, 4, 6 blocks. Group 1 or the slow advancement group included 64 newborns babies andGroup 2 or the rapid advancement group included 69 newborns babies. Results: The average weight gain in Group 1 was4.41 ± 0.9 g and in Group 2 it was 6.33 ± 1.3 g, the difference was statistically significant (p < 0.02). Sixty out of 64 newbornsregained birth weight within 16.87 ± 0.9 days in Group 1, while 64 out of 69 newborns regained birth weight within 13.63 ±0.9 days in Group 2. The difference was statistically significant. Increment in the mean occipitofrontal circumference perweek was 0.29 ± 0.27 cm Group 1, while in Group 2 it was 0.42 ± 0.05 cm; the difference was statistically significant. Meanaverage length increment per week was found to be 0.55 ± 0.04 cm and 0.69 ± 0.05 cm in Group 1 and Group 2, respectively,the difference was statistically significant (p < 0.005). The mean duration of hospital stay was 27.47 ± 3.33 days in Group 1while in Group 2, the duration of stay was 23.15 ± 2.22 days, the difference was statistically significant. Conclusion: Ourstudy supports enteral nutrition by rapid enteral feeding regimen in stable preterm neonates with very low birth weight

Slow verses rapid advancement of enteral feed in preterm neonates of 28-34 weeks of gestational age with abnormal antenatal umbilical artery Doppler: A randomised controlled trial

Background: Necrotising enterocolitis (NEC) is the commonest and most serious gastrointestinal neonatal emergency. In preterm infants with evidence of abnormal Doppler flow velocities in the fetal umbilical artery, suboptimal intestinal perfusion is postulated to increase the risk of feed intolerance and NEC.Objectives: To compare the effect of slow versus rapid enteral feeding in preterm neonates with abnormal antenatal umbilical artery Doppler.Method: This is a randomised controlled trial; we randomised into a slow and a fast group; we randomised separately into subcategories based on the weight. Sample size was calculated as 82. Data analysis was done using SPSS version 23. For group comparisons of categorical data, Chi-squared test was used. If expected frequency in the contingency tables was <5 for more than 25% cells, Fisher’s exact test was used. For non-parametric continuous data Mann-Whitney test was applied. Statistical significance was kept at p<0.05 and power at 80%.Results: In neonates with slow and rapid feeding with birth weight <1250g, percentage of 2b (30% and 26.7% respectively) was more compared to other stages, whereas in group with birth weight ≥1250g rapid feeding group Ia (14.3%) was more in slow feeding group and 1a and 2a equal in rapid feeding group with no statistical significance. The mean duration of stay hospital was less in rapid feeding group in both birth strata. The sepsis percentage was more in the slow feeding group. Regarding mortality in both groups, there was no statistical difference.Conclusions: In this study the type of feeding did not affect NEC or feeding intolerance in preterm infants. Rapid feeding had a significant impact on sepsis and length of stay in preterm infants.

Noninvasive Ventilation and Rapid Enteral Feeding Advances in Preterm Infants-2-Year Follow-Up of the STENA-Cohort.

The importance of nutritional supply for somatic growth and neurodevelopmental outcome in very-low-birthweight infants is an established medical strategy for reducing long-term morbidities. Our cohort study on rapid enteral feeding advances using a standardized protocol (STENA) previously demonstrated a 4-day reduction of parenteral nutrition. STENA did not impede the success of noninvasive ventilations strategies but significantly less infants required mechanical ventilation. Most importantly, STENA resulted in improved somatic growth at 36 weeks of gestation. Here, we evaluated our cohort for psychomotor outcomes and somatic growth at 2 years of age. n = 218 infants of the original cohort were followed-up (74.4%). Z-scores for weight and length did not differ but the benefits of STENA for head circumference persisted until the age of 2 years (p = 0.034). Concerning the psychomotor outcome, we neither found any statistically significant differences in the mental developmental index (MDI) (p = 0.738), norin the psychomotor developmental index (PDI) (p = 0.122). In conclusion, our data adds important insights on the topic of rapid enteral feeding advances and confirms the safety of STENA with respect to somatic growth and psychomotor outcome measures.

Cover Image, Volume 57, Number 5, May 2022

Front Cover Caption: The cover image is based on the Original Article Compatibility of rapid enteral feeding advances and noninvasive ventilation in preterm infants–An observational study by Judith Behnke et al., https://doi.org/10.1002/ppul.25868.

Addressing Health Concerns Interrupted by the COVID-19 Pandemic

Addressing Health Concerns Interrupted by the COVID-19 Pandemic

Rapid versus Slow Feeding Advancement in Preterm Low Birth Weight Neonates: A Systematic Review and Meta-analysis

Objectives. To compare the clinical outcomes of rapid versus slow enteral feeding advancement in preterm low birth weight neonates.
 Methods. Searches for randomized controlled trials evaluating the effect of rapid versus slow rate of enteral feeding advancement on the clinical outcomes of preterm, low birth weight neonates were performed in different databases. Two authors screened the articles for inclusion and statistical analysis was done using Review Manager Version 5.3 (RevMan) software.
 Results. Six trials with a total of 680 subjects comparing enteral feeding advancement protocols were identified. The number of days to reach full feeds in rapid enteral feeding was shorter by 2.79 days (95% CI 1.39, 4.19) and time to regain weight by 3.72 days (95% CI 2.86, 4.59) compared to slow enteral feeding. There was no significant difference in the incidence of feeding intolerance (OR 0.69, 95% CI 0.42, 1.11) and NEC (OR 0.88, 95% CI 0.45, 1.72) between the two groups.
 Conclusions. Rapid enteral feeding protocols reduce the time to establish full enteral feeds and to regain birth weight in preterm low birth weight neonates. Rapid enteral feeding may facilitate early discharge and help reduce hospital costs for the care of these neonates.

Compatibility of rapid enteral feeding advances and noninvasive ventilation in preterm infants-An observational study.

To evaluate safety and clinical outcome of rapid enteral feeding advances in preterm infants <1500 g birthweight (BW). In this single-center retrospective cohort study, 293 preterm infants born during 2015-2018 were comparatively analyzed before (n = 145) and after (n = 148) the implementation of a rapid enteral feeding protocol with daily milk increments of 20-30 ml/kgof body weight. Major outcome parameters were focused towardpulmonary morbidities and nutritional variables. Preterm infants in the rapid feeding advancement group were more successfully stabilized on noninvasive ventilation (p < 0.001) never requiring mechanical ventilation. Duration of respiratory support (0.465) and frequency of bronchopulmonary dysplasia (BPD) (p = 0.341) and severe BPD (0.273) did not differ between both groups. Furthermore, patients in the rapid feeding group achieved full volume feedings faster (p < 0.001), regained BW earlier (p = 0.009), and displayed significantly improved somatic growth at 36 weeks gestational age (p < 0.001). There was no increased risk for further morbidities of prematurity including feeding intolerance, necrotizing enterocolitis (NEC), and focal intestinal perforation. Rapid enteral feeding advancements in preterm infants <1500 g BW are safe and do not impede stabilization on noninvasive ventilation.

Commentary on "compatibility of rapid enteral feeding advances and noninvasive ventilation in preterm infants-an observational study".

Nutritional support is essential in the critical care of the very preterm infant, however, the study of the potential role of nutrition in the multifactorial pathogenesis of bronchopulmonary dysplasia (BPD) is limited. Achievement of full enteral feeding faster has not been shown to be harmful and may be of benefit in extremely preterm infants. This commentary discusses the studied risk and potential benefits of more rapid enteral feeding advancement in extremely preterm infants.

A review of best evidenced-based enteral and parenteral nutrition support practices for preterm infants born &lt;1,500 grams

Nutrition monitoring must remain a priority for very low birth weight infants who are at high risk for nutritional deficiencies and growth failure. Research demonstrates that as many as 50% of North American infants experience extrauterine growth failure, primarily attributable to inadequate nutrition delivery. Consequently, the purpose of this review is to identify the best enteral and parenteral nutrition management practices for preterm infants born <1,500 grams. Nutrition recommendations set forth for preterm infants by leading references were reviewed and compared. Infant nutrition and growth studies identified by extensive literature review were also assessed in comparison to current recommendations, neonatal clinical experience, and gaps within clinical practice. Modern literature demonstrates that more aggressive parenteral nutrition provision, early enteral feeding initiation, more rapid enteral feeding advancement, and early human milk fortification are well tolerated and promote improved nutrition, growth, and clinical outcomes. This review identifies clinically feasible and evidenced-based enteral and parenteral nutrition support practices that promote best outcomes for very low birth weight infants.

Does rapid enteral feeding increase intestinal morbidity in very low birth weight infants? A retrospective analysis

Purpose: To investigate the association of a standardized rapid enteral feeding strategy (established in 2011 in our unit) with intestinal morbidity in very low birth weight (VLBW) infants. Methods: A total of 301 inborn VLBW infants were included in this single-centre retrospective cohort study. We compared the incidence of intestinal morbidity (defined as necrotizing enterocolitis or intestinal perforation) in slowly enterally fed infants in 2008–2010 (10 ml/kg/day increase of milk feeds) to a corresponding cohort of rapidly enterally fed infants in 2011–2013 (20 ml/kg/day increase of milk feeds). Univariate and multivariable logistic and linear regression analyses, respectively, were performed to control for confounding variables. Results: Both groups were similar regarding baseline demographic and perinatal characteristics. In univariate modeling, intestinal morbidity did not significantly differ between the two groups (p = 0.25), neither did all-cause mortality nor incidence of late onset sepsis in multivariable modeling. In contrast, length of hospital stay (HS) and duration of parenteral nutrition (PEN) were significantly shorter in the rapid group (HS: −8.35 days, p = 0.012 and PEN: −7.13 days, p < 0.001). Conclusions: Implementation of a more rapid enteral feeding regime is safe in VLBW infants and may significantly shorten length of HS and PEN in this cohort.

Brief Parenteral Nutrition Accelerates Weight Gain, Head Growth Even in Healthy VLBWs

IntroductionWhether parenteral nutrition benefits growth of very low birth weight (VLBW) preterm infants in the setting of rapid enteral feeding advancement is unclear. Our aim was to examine this issue using data from Japan, where enteral feeding typically advances at a rapid rate.MethodsWe studied 4005 hospitalized VLBW, very preterm (23–32 weeks' gestation) infants who reached full enteral feeding (100 ml/kg/day) by day 14, from 75 institutions in the Neonatal Research Network Japan (2003–2007). Main outcomes were weight gain, head growth, and extra-uterine growth restriction (EUGR, measurement <10th percentile for postmenstrual age) at discharge.Results40% of infants received parenteral nutrition. Adjusting for maternal, infant, and institutional characteristics, infants who received parenteral nutrition had greater weight gain [0.09 standard deviation (SD), 95% CI: 0.02, 0.16] and head growth (0.16 SD, 95% CI: 0.05, 0.28); lower odds of EUGR by head circumference (OR 0.66, 95% CI: 0.49, 0.88). No statistically significant difference was seen in the proportion of infants with EUGR at discharge. SGA infants and infants who took more than a week until full feeding had larger estimates.DiscussionEven in infants who are able to establish enteral nutrition within 2 weeks, deprivation of parenteral nutrition in the first weeks of life could lead to under nutrition, but infants who reached full feeding within one week benefit least. It is important to predict which infants are likely or not likely to advance on enteral feedings within a week and balance enteral and parenteral nutrition for these infants.

Rapid Versus Slow Advancement of Feeds in Preterm Babies Less than 34 Weeks in Incidence of NEC and Feed Intolerance

Objective: To evaluate whether preterm neonates less than 34 weeks at birth receiving rapid enteral feeding advancement at 25-30 ml/kg/day and those receiving slow enteral feeding advancement at 15-20 mL⁄kg⁄day to attain full feeding (180 ml/kg/day) are atincrease in the incidence of necrotizing enterocolitis or feed intolerance. Study design: Retrospective cohort study. Setting: Level III Neonatal Unit in Southern India Subjects: Neonates born at <34 weeks of gestational age and admitted to the NICU during study period were enrolled. Outcome: Mortality and major morbidity - NEC as per Bell staging, incidence of feedintolerance. Results: Both groups had similar baseline characteristics. The average gain in weight, length and head circumference were significantly lower in the slow feeding group as compared rapid feeding group. The mean days to reach birth weight was less in rapid feeding group; 12.43 vs. 15.46 in slow feeding group (p=0.04). It was inferred that duration of hospital stay (22.58 vs. 31.34 days) and parenteral nutrition( 8.69 vs. 11.18 days) was less in rapid feeding group as compared to slow feeding group (p= 0.04). Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation Rapid feeding group does not have increased episodes of feed intolerance or NEC (5 vs. 6 cases) compared to slow feeding group. Conclusions: Our study support enteral nutrition by rapid enter

102 Randomized, Controlled Trial of Slow Versus Rapid Enteral Feeding Advancements on the Clinical Outcomes of Preterm Infants 750–1250g

ObjectiveTo evaluate the effect of slow versus rapid rates of advancement of enteral feed volumes upon the clinical outcomes in preterm infants with 750–1250g birth weight.Study DesignA total of 92...

Randomized Controlled Trial of Slow vs Rapid Enteral Feeding Advancements on the Clinical Outcomes of Preterm Infants With Birth Weight 750–1250 g

To evaluate the effect of slow vs rapid rates of advancement of enteral feed volumes on the clinical outcomes in preterm infants with 750-1250 g birth weight. A total of 92 stable neonates 750-1250 g and gestational age <32 weeks were randomly allocated to enteral feeding advancement of 20 mL/kg/d (n = 46) or 30 mL/kg/d (n = 46). The primary outcome was days to reach full enteral feeding, defined as 180 mL/kg/d. Secondary outcomes included rates of necrotizing enterocolitis (NEC) and culture-proven sepsis, days of parenteral nutrition (PN), length of hospital stay, and growth end points. Neonates in the rapid-feeding advancement group achieved full enteral volume of feedings earlier than the slower advancement group. They received significantly fewer days of PN, exhibited a shorter time to regain birth weight, and had a shorter duration of hospital stay. The incidence of NEC and the number of episodes of feeding intolerance were not significantly different between the groups, whereas the incidence of culture-proven late-onset sepsis was significantly less in infants receiving a rapid feeding advancement. Excluding infants who were small for gestational age at birth, the incidence of extrauterine growth restriction was significantly reduced in the rapid-advancement group at 28 days and at hospital discharge. Rapid enteral feeding advancements in 750-1250 g birth weight infants reduce the time to reach full enteral feeding and the use of PN administration. Rapid-advancement enteral feed also decreases extrauterine growth restriction with improved short-term outcomes for these high-risk infants.

Standardisierte Ernährung zum enteralen Nahrungsaufbau für Frühgeborene mit einem Geburtsgewicht ≤1 750 g - kontrollierte randomisierte Studie

Rapid enteral feeding volume advancement in preterm infants can reduce the use of intravenous fluids. This practice may decrease the hazards of intravenous infusion solutions and potentially the morbidity rate. Several cohort trials demand the standardised nutritional regimen to reduce the complications and the time to reach full enteral feeds. to determine whether using a standardized nutritional regimen the rapid enteral feeding advancement in preterm infants is practicable without increasing the incidence of feeding complications. A prospective, randomized, controlled trial was performed in 99 preterm infants, birth weight ≤1,750 g. Group ST (standardized nutritional regimen) received breast human milk according to a standardized nutritional regimen. Group IN (individual nutritional regimen) received breast human milk or semi-elemental nutrition (Pregomin(®) Milupa) depending on enteral problems of the infant. The feeding volume advancement in the IN-Group was decided individually. The main outcome measure was time to reach full enteral feedings. Infants in the ST-Group achieved full enteral feedings after 14.93±9.95 (median 12) d, infants in the IN-Group after 16.23±10.86 (median 14) d. The difference between the groups was significant only in small for gestational age (SGA) infants: ST-Group 10.20±4.78 (median 8.5) vs. IN-Group 16.73±8.57 (Median 15) days (p=0.045). The weight gain was similar in both groups. Infants in ST-Group achieved full enteral feedings having 116% of birth weight, infants in IN-Group 122% of birth weight. This difference was not significant (p=0.195). The incidence of NEC (necrotizing enterocolitis, 4%) and other complications were low in both groups. The diagnosis "feeding complications" was described in IN-Group in 14 vs. 7 infants in ST-Group. SGA-infants profit from the enteral feeding advancement by using a standardized nutritional regimen. These infants achieved full enteral feedings sooner then the SGA-infants, who did not feed by using a standardized nutritional regimen. A standardized nutritional regimen can be realized in clinical routine and is by strict clinical observation practicable without increasing the incidence of feeding complications.

Slow versus rapid enteral feeding advancement in preterm newborn infants 1000–1499g: a randomized controlled trial

Slow versus rapid enteral feeding advancement in preterm newborn infants 1000–1499g: a randomized controlled trial

Slow versus rapid enteral feeding advancement in preterm newborn infants 1000–1499 g: a randomized controlled trial

To evaluate whether preterm neonates weighing 1000-1499 g at birth receiving rapid enteral feeding advancement at 30 mL/kg/day attain full feedings (180 mL/kg/day) earlier than those receiving slow enteral feeding advancement at 20 mL/kg/day without increase in the incidence of feeding intolerance or necrotizing enterocolitis. A total of 100 stable intramural neonates weighing between 1000 and 1499 g and gestational age less than 34 weeks were randomly allocated to enteral feeding (expressed human milk or formula) advancement of 20 mL/kg/day (n = 50) or 30 mL/kg/day (n = 50). Neonates in the rapid feeding advancement group achieved full volume feedings before the slow advancement group (median 7 days vs. 9 days) (p < 0.001), had significantly fewer days of intravenous fluids (median 2 days vs. 3.4 days) (p < 0.001), shorter length of stay in hospital (median 9.5 days vs. 11 days) (p = 0.003) and regained birth weight earlier (median 16 days vs. 22 days) (p < 0.001). There were no statistical differences in the proportion of infants with apnea, feed interruption or feed intolerance. Rapid enteral feeding advancements of 30 mL/kg/day are well tolerated by stable preterm neonates weighing 1000-1499 g.