Delayed initiation of enteral feeds is associated with postnatal growth failure among preterm infants managed at a rural hospital in Uganda

Nakubulwa, Clare; Musiime, Victor; Namiiro, Flavia; Tumwine, James K; Hongella, Christine; Nyonyintono, James; Hedstrom, Anna B.; Opoka, Robert O.

doi:10.1186/s12887-020-1986-5

Cited by 10 publications

(15 citation statements)

References 18 publications

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“…Early initiation of breast milk feeding signi cantly reduced the duration of regaining birth weight more than three days in the intervention group when compared to the controls. This nding demonstrates the bene t of early enteral feeding in the prevention of postnatal growth failure and is consistent with studies from Uganda [12], Iran [25] and India [11,29]. However, this did not correspond with a shortened hospital stay as shown in previous studies [11,25] and may be explained by other factors such as neonatal sepsis which may impact on the early stabilization of the neonates.…”

Section: Discussionsupporting

confidence: 90%

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Enhancing early breast milk for sick and preterm neonates admitted at regional referral hospitals in Dar es Salaam, Tanzania

Hyera¹,

Assenga²,

Kazimoto³

et al. 2020

Preprint

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Background: Feeding is a cornerstone in the management of sick or preterm neonates and early initiation of breastfeeding is the single most effective intervention associated with reduced neonatal mortality. However, enteral feeding is often delayed due to haemodynamic instability and the perceived risk of necrotizing enterocolitis (NEC). Alternative routes for early breast milk administration are either oropharyngeal colostrum or minimal enteral nutrition. One strategy to overcome delays in enteral feeds is the implementation of standardized feeding guidelines.Methods: This study was conducted in three regional hospitals in Dar es Salaam, consisting of a historical control group at baseline and an intervention group after implementation of locally developed feeding guidelines. Neonates were consecutively recruited and followed to a maximum of 28 days of life. The controls received routine standard care, while the intervention group received early enteral feeding. The outcomes measured were NEC, time to regain birth weight and neonatal mortality. Odds ratio was used to determine the association between feeding and outcomes, statistical significance was considered when p-value ≤0.05.Results: 292 neonates were enrolled in this study, 163 (55.8%) controls at baseline and 129 (44.2%) after the intervention. Study participants comprised of 130 (44.5%) neonates with very low birth weight and 162 (55.5%) with hypoxic ischemic encephalopathy. The mean age of initiating feeding was 45.34 ± 21.58 SD hours amongst the controls and 8.43 ± 3.02 SD hours in the intervention group. Overall, 1.4% (4 cases) of the neonates were diagnosed with NEC, 1.8% (3 cases) in the control group and 0.8 % (1 case) in the intervention group (P=0.4; 95% CI: 0.25-23.3). The mean duration of regaining birth weight was significantly reduced from 11.26 ± 4.34 SD days among controls to 8.25 ± 2.96 SD days in the intervention group (p=0.000; 95% CI: 1.61 - 4.41). Mortality in this high-risk groups of neonates remained high (40.8%), without significant difference between the control (41.7%) and intervention group (39.5%). Conclusions: Neonates who received early breast milk feeding following the implementation of feeding guidelines significantly regained birth weight earlier. No association was demonstrated between early breast milk feeding and increased NEC or mortality.

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Section: Discussionsupporting

confidence: 90%

“…Furthermore, previous studies have demonstrated that delayed initiation of enteral feeds leads to signi cant postnatal growth failure and adverse neonatal outcomes, especially in low resource settings where total parenteral nutrition for neonates is not readily available [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Enhancing early breast milk for sick and preterm neonates admitted at regional referral hospitals in Dar es Salaam, Tanzania

Hyera¹,

Assenga²,

Kazimoto³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Early initiation of breast milk feeding signi cantly reduced the duration of regaining birth weight more than three days in the intervention group when compared to the controls. This nding demonstrates the bene t of early enteral feeding in the prevention of postnatal growth failure and is consistent with studies from Uganda [13], Iran [26] and India [12,30]. However, this did not correspond with a shortened hospital stay as shown in previous studies [12,26] and may be explained by other factors such as neonatal sepsis which may impact on the early stabilization of the neonates.…”

Section: Discussionsupporting

confidence: 90%

Enhancing early initiation of breast milk for sick and preterm neonates admitted at regional referral hospitals in Dar es Salaam, Tanzania

Hyera¹,

Assenga²,

Kazimoto³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Feeding is the cornerstone in the management of sick or preterm neonates and early initiation of breastfeeding is the single most effective intervention associated with reduced neonatal mortality. Alternative routes for early breast milk administration are either oropharyngeal colostrum or minimal enteral nutrition. However, enteral feeding is often delayed due to haemodynamic instability and the perceived risk of necrotizing enterocolitis (NEC). One strategy to overcome delays in enteral feeds is the implementation of standardized feeding guidelines.Methods: This study was conducted in three regional hospitals in Dar es Salaam, consisting of a historical control group at baseline and an intervention group after implementation of co-created and locally adapted feeding guidelines. Neonates were consecutively recruited and followed to a maximum of 28 days of life. The controls received routine standard care, while the intervention group received early enteral feeding. The outcomes measured were NEC, time to regain birth weight and neonatal mortality. Odds ratio was used to determine the association between feeding and outcomes, statistical significance was considered when p-value ≤0.05.Results: 292 neonates were enrolled in this study, 163 (55.8%) controls at baseline and 129 (44.2%) after the intervention. Study participants comprised of 130 (44.5%) neonates with very low birth weight and 162 (55.5%) with hypoxic ischemic encephalopathy. The mean age of initiating feeding was 45.34 ± 21.58 SD hours amongst the controls and was significantly reduced to 8.43 ± 3.02 SD hours in the intervention group. Overall, 1.4% (4 cases) of the neonates were diagnosed with NEC, 1.8% (3 cases) in the control group and 0.8 % (1 case) in the intervention group (P=0.4; 95% CI: 0.25-23.3). The mean duration of regaining birth weight was significantly reduced from 11.26 ± 4.34 SD days among controls to 8.25 ± 2.96 SD days in the intervention group (p=0.000; 95% CI: 1.61 - 4.41, n = 110). Mortality in these high-risk groups of neonates remained high (40.8%, n = 119), without significant difference between the control (41.7%) and intervention group (39.5%). Conclusions: After implementation of co-created and contextualized feeding guidelines the mean duration of initiating mother’s milk was significantly reduced. Neonates in the intervention group who received early breast milk feeding significantly regained birth weight earlier. However, the study was underpowered to detect a small difference in important outcomes, including NEC and mortality. A randomized study with a large sample size and high power is recommended to further confirm the safety of early provision of mother’s milk among high-risk neonates in a low resource setting.Trial registration: The study was registered on October 3, 2018 to the Pan African Clinical Trial Registry (www.pactr.org) under the identification number PACTR201810856025709.

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“…Delayed trophic feeding: indicates when the neonates start trophic feeding after 24 hours of birth. 22 , 23 …”

Section: Sampling Technique and Proceduresmentioning

confidence: 99%

Necrotizing Enterocolitis and Its Predictors Among Preterm Neonates Admitted in Neonatal Intensive Care Units of Gurage Zone Public Hospitals, Southwest Ethiopia, 2021

Chekole

Mewahegn

GebreEyesus

et al. 2022

PHMT

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Background Necrotizing Enter colitis (NEC) is the most common multifactorial and devastating gastrointestinal emergency which primarily affects premature infants. The purpose of this study was to identify the prevalence of Necrotizing Enterocolitis and its associated factors among preterm neonates admitted to Neonatal Intensive Care Units in Gurage Zone hospitals. Methods Institution-based cross-sectional study design was employed. The simple Random Sampling Technique was applied to collect the data using a structured questionnaire. Data were cleaned, checked for inconsistencies, coded and entered via EPI data 3.1, and exported to Stata version 14 for further analysis. The data were processed by Stata 14 to estimate the prevalence of necrotizing enterocolitis. Results The prevalence of Necrotizing Enterocolitis among neonates was 28 (9.7%) 95% CI of 6. 8–13.7%. Birth weight (AOR: 7.33 95% CI (2.04: 26.38)), presence of maternal infection (AOR: 6.09, 95% CI (1.31:28.26)), length of hospital stay (AOR: 3.28, 95% CI (1.20, 8.96)), and initiating trophic feeding (AOR: 5.89, 95% CI (2.27: 15.33)) were associated with neonatal necrotizing enterocolitis. Conclusion The prevalence of Necrotizing Enterocolitis among preterm neonates was significant and special attention is needed for premature neonates with low birth weight and born from mothers with infection during pregnancy. Minimizing the length of hospital stay will be very useful to prevent the occurrence of Necrotizing Enterocolitis.

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Delayed initiation of enteral feeds is associated with postnatal growth failure among preterm infants managed at a rural hospital in Uganda

Cited by 10 publications

References 18 publications

Enhancing early breast milk for sick and preterm neonates admitted at regional referral hospitals in Dar es Salaam, Tanzania

Enhancing early breast milk for sick and preterm neonates admitted at regional referral hospitals in Dar es Salaam, Tanzania

Enhancing early initiation of breast milk for sick and preterm neonates admitted at regional referral hospitals in Dar es Salaam, Tanzania

Necrotizing Enterocolitis and Its Predictors Among Preterm Neonates Admitted in Neonatal Intensive Care Units of Gurage Zone Public Hospitals, Southwest Ethiopia, 2021

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