ABSTRACT.Objective. To test the hypothesis that very low birth weight infants fed by continuous nasogastric gavage (CNG) would achieve full enteral feedings (100 kcal/kg/d) at an earlier postnatal age and have less feeding intolerance (FI) than infants fed by intermittent bolus gavage (IBG).Methods. Eighty infants were stratified by birth weight (700 to 1000 g and 1001 to 1250 g) and randomized into CNG or IBG feeding groups. CNG infants were comparable with IBG in birth weight, gestational age, sex, race, and day of onset of feeding (5.7 ؎ 2.1 days vs 5.6 ؎ 2.2 days, respectively). Feedings were given as undiluted Similac Special Care formula (Ross Laboratories, Columbus, OH) via a specific protocol designed for each 50 to 100 g birth weight category. Feedings were advanced isoenergetically by a maximum of 25 mL/kg/d until an endpoint of 100/kcal/kg/d for at least 48 hours was reached. An infant whose feedings were withheld for >12 hours based on predetermined criteria was considered to have an episode of FI.Results. Infants in the CNG group reached full enteral feeding at 17.1 ؎ 8.9 days compared with 15.5 ؎ 5.5 days in the IBG group; these were not statistically different. Secondary outcome variables such as days to regain birth weight (CNG, 12.6 ؎ 5 days vs IBG, 12.5 ؎ 3.7 days), days to reach discharge weight of 2040 g (CNG, 60 ؎ 13.4 days vs IBG, 62 ؎ 13.6 days), and number of episodes of FI were not significantly different between feeding methods. FI was primarily associated with birth weight <1000 g (71%) vs 1001 to 1250 g (38%).Conclusion. Feeding methods are associated with similar outcomes when feeding regimens are comparable. Pediatrics 1997;100(4). URL: http://www.pediatrics. org/cgi/content/full/100/4/e4; premature infants, feeding methods, feeding intolerance, gastric residual.

Prenatal and Birth History • 22-year-old G2P1 African American mother • Estimated gestational age: 38 weeks • Spontaneous vaginal delivery in hospital • Nonconsanguineous parents • Routine antenatal screen negative • Apgar scores 9 and 9 at 1 and 5 minutes.

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Spleen rupture in an extremely premature newborn is very rare event. High index of suspicion is required to make timely diagnosis and thereafter appropriate management. We present a rare case of an extremely premature, extremely low birthweight newborn who presented with severe anemia secondary to splenic rupture. It was managed conservatively without splenectomy resulting in complete resolution of symptoms. Although non-operative management of pediatric splenic injuries is now recognized as the treatment of choice, there is very little experience in premature newborns.