Aims-To determine the eVect of trophic feeding on clinical outcome in ill preterm infants. Methods-A randomised, controlled, prospective study of 100 preterm infants, weighing less than 1750 g at birth and requiring ventilatory support and parenteral nutrition, was performed. Group TF (48 infants) received trophic feeding from day 3 (0.5-1 ml/h) along with parenteral nutrition until ventilatory support finished. Group C (52 infants) received parenteral nutrition alone. "Nutritive" milk feeding was then introduced to both groups. Clinical outcomes measured included total energy intake and growth over the first six postnatal weeks, sepsis incidence, liver function, milk tolerance, duration of respiratory support, duration of hospital stay and complication incidence. (Arch Dis Child Fetal Neonatal Ed 2000;82:F29-F33) Results-Groups

A study was carried out to identify the characteristics of children who do not attend appointments at general outpatient clinics. Over six months, 359 children who had an appointment at a general clinic were studied using a questionnaire given to parents (740/o response rate) and by inspection of case notes. Based on their first appointment in the study period, children were divided into 'attenders' (n=262) and 'non-attenders' (n=97) for analysis. Nonattenders were significantly more likely to have one or more of the foilowing characteristics: lower social class, poorer housing, unmarried parent(s) (56% v 330/%), longer journey to clinic (35 v 27-6 minutes), more appointments per year (4.2 v 3.3), poorer past attendance record, and received their appointment by post (76% v 44%). Surprisingly parents of nonattenders rated their children to have a significantly more severe illness than those who attended. These results suggest that attendance is primarily determined by social and logistical factors as weil as appointment details, rather than illness severity. (Arch Dis Child 1996; 74: 121-125)

Aim-To determine the eVect of cisapride on gastrointestinal motility in preterm infants. Methods-Cisapride (0.2 mg/kg, 8 hourly ) or placebo was given first for seven days in a double blind randomised crossover study of 10 preterm infants. Gastrointestinal motility was assessed on day 3 of each treatment. The half gastric emptying time (GET 1 ⁄2) was determined by using ultrasonography to measure the decrease in the gastric antral cross sectional area after a feed. The whole gastrointestinal transit time (WGTT) was assessed by timing the transit of carmine red through the gut. Treatments were compared using the Wilcoxon matched pairs signed ranks test. Results-Median (range) birthweight was 1200 (620, 1450) g and postconceptional age 33 (29, 34) weeks at recruitment. GET 1 ⁄2 was significantly longer during cisapride treatment than during placebo; the median of the diVerences (95% confidence interval) was 19.2 (11, 30 minutes, p=0.008). WGTT was also longer during cisapride treatment, but the diVerence was not significant; the median of the differences was 11(−18, 52 hours, p=0.1). Conclusions-Cisapride delays gastric emptying and may delay WGTT in preterm infants. Its use to promote gastrointestinal motility in this group cannot be recommended. (Arch Dis Child Fetal Neonatal Ed 1999;80:F174-F177)

Population-based interventions for the prevention of fall-related injuries in older people.

Objectives-To determine the eVect of trophic feeding on gastric emptying and whole gut transit time in sick preterm infants. Methods-A randomised, controlled, prospective study of 70 infants weighing less than 1750 g at birth, who were receiving ventilatory support, was performed. Group TF (33 infants) received trophic feeding from day 3 (0.5 ml/h if birthweight less than 1 kg, 1 ml/h if greater or equal to 1 kg) in addition to parenteral nutrition until ventilatory support finished. Group C (37 infants) received parenteral nutrition alone until ventilatory support finished. Expressed breast milk or a preterm formula were given according to maternal preference. Gastric emptying was assessed within 24 hours of nutritive milk feeding equal to 90 ml/kg/day, using ultrasound scans to measure the reduction in the gastric antral cross sectional area after a feed. Whole gut motility was assessed at both 3 and 6 weeks of age by measuring the whole gut transit time (WGTT) of the marker carmine red. Results-There was no significant diVerence between groups in their gastric half emptying time, median diVerence (95% confidence interval) 2.6 (−5.9, 13.9) minutes. The WGTT was significantly faster (p<0.05) in group TF at both 3 and 6 weeks; median diVerence −13 (−47, −0.1) and −12.5 (−44, −0.5) hours, respectively. Conclusions-Trophic feeding enhances whole gut motility but not gastric emptying. This eVect could subsequently improve milk tolerance in sick preterm infants. (Arch Dis Child Fetal Neonatal Ed 1999;80:F54-F58)