Abstract
Objective Early establishment of enteral feeds is desirable in very preterm infants, but it
may be associated with feeding intolerance. Several feeding methods have been studied
with no strong evidence to suggest the preferred feeding method to establish early
full enteral feeds. We studied three modalities of feeding in preterm infants ≤32
weeks and ≤1,250 g: continuous infusion (CI), intermittent bolus by infusion (IBI),
and intermittent bolus by gravity (IBG) for their effect on time to reach full enteral
feeds of 180 mL/kg/d.
Study Design We randomized 146 infants, 49 infants in each CI and IBI group and 48 infants in
the IBG group. In the CI group, feeds were delivered by an infusion pump continuously
over 24 hours. In the IBI group, feeds were given every 2 hours and infused over 15 minutes
by an infusion pump. In the IBG group, feeds were delivered by gravity over 10 to
30 minutes. The intervention was continued till infants reached direct breast/cup
feeds.
Results The mean (standard deviation) gestation in CI, IBI, and IBG groups were 28.4 (2.2),
28.5(1.9), and 28.6 (1.8) weeks, respectively. The time to reach full feeds in CI,
IBI, and IBG were not significantly different (median [interquartile range]: 13 [10–16],
11.5 [9–17], and 13 [9.5–14.2] d, respectively, p = 0.71). The proportions of infants who developed feeding intolerance in CI, IBI,
and IBG were similar (n [%]: 21 [51.2%], 20 [52.6%], and 22 [64.7%], respectively, p = 0.45). There was no difference in necrotizing enterocolitis ≥2 (p = 0.80), bronchopulmonary dysplasia (p = 0.86), intraventricular hemorrhage ≥2 (p = 0.35), patent ductus arteriosus requiring treatment (p = 0.44), retinopathy of prematurity requiring treatment (p = 0.51), and growth parameters at discharge.
Conclusion In preterm infants, ≤32 weeks of gestation and birth weight ≤1,250 g, there was no
difference in time to reach full enteral feeds in the three modalities of feeding.
This study is registered with Clinical Trials Registry India (CTRI) and the registration
number is CTRI/2017/06/008792.
Key Points
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Gavage feeding in preterm infants is either continuous or intermittent bolus feeding.
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Intermittent bolus feeding was evaluated in a controlled time by infusion over 15 minutes.
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The time to reach full feeds was comparable for all three methods.
Keywords
feeding intolerance - growth velocity - very low birth weight infants - feeding methods
