Early Total Enteral Feeding in Stable Very Low Birth Weight Infants: A Before and After Study

Nangia, Sushma; Bishnoi, Amit; Goel, Ankita; Mandal, Piali; Tiwari, Soumya; Saili, Arvind

doi:10.1093/tropej/fmx023

Cited by 24 publications

(13 citation statements)

References 21 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: 91%

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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: 91%

“…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

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“…A South African study on growth of 92 extremely low birth weight preterm infants at a tertiary hospital also found that being kept nil per os beyond the first day of life was significantly associated with poor growth [12]. Earlier enteral feeding results in earlier achievement of full enteral feeds which CPAP Continuous positive airway pressure, iqr Interquartile range, NEC Necrotizing enterocolitis, PDA Patent ductus arteriousus, NGT Nasal gastric tube, N = 349 a indicates where we had some missing data means reduced cumulative protein and energy deficits and therefore more weight gain [13]. In low resource settings where parenteral nutrition is not widely used, earlier initiation of enteral feeds may best optimize postnatal nutrition.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Background: Prematurity is the leading cause of mortality in children under 5 years of age globally and is also frequently associated with postnatal growth failure (PGF). Although most preterm births occur in low resource settings, little is known about their postnatal growth outcomes especially in rural areas. We evaluated the incidence and factors associated with PGF among preterm infants managed at a rural hospital in Uganda. Methods: Retrospective cohort study of preterm infants discharged from Kiwoko Hospital neonatal intensive care unit (NICU) from July 2017 to June 2018. Inclusion criteria included gestational age 26 up to but not including 37 weeks, admission within 24 h of birth and at least 7 days hospital stay. Exclusion criteria included major congenital anomalies and missing gestational age or birth weight. Birth and discharge weights from clinical notes were plotted on Fenton 2013 growth charts. Gestation age was determined by last normal menstruation period (LNMP), extracted from the mother's antenatal card or early obstetric ultrasound scan reports. Postnatal growth failure was diagnosed if discharge weight was less than the 10th percentile for estimated gestational age. Other data from the clinical notes included demographic characteristics, neonatal morbidities as assigned by the attending physician and infant feeding practices. Multivariable logistic regression was used to explore factors associated with PGF. Results: A total of 349 preterm infants with a mean gestational age of 31 (range 26 to 36) weeks were included. The incidence proportion of PGF was 254/349 (73%). Factors significantly associated with postnatal growth failure included: delayed initiation of enteral feeds [AOR = 3.70, 95% (CI 1.64 to 8.33)], sepsis [AOR = 6.76, 95% (CI 2.15 to 21.2)], multiple gestation [AOR = 1.81, 95% (CI 1.01 to 3.24)] and male gender [AOR = 1.71 95% (CI 1.01 to 2.91)]. Conclusion: Nearly three quarters of preterm infants managed at a rural hospital in Uganda had postnatal growth failure. Delayed initiation of enteral feeds and sepsis were highly associated with postnatal growth failure. Enteral feeds should be initiated as soon as possible in these infants to reduce early protein deficits and hence postnatal growth failure.

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“…The NICUs are considered to be important focus areas for HAI surveillance and antibiotic stewardship [ 1 , 5 , 6 , 12 ]. Minimal enteral nutrition and early total enteral nutrition has been shown to reduce the risk of sepsis and the duration of hospital stays [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence and Determinants of Health Care-Associated Blood Stream Infection at a Neonatal Intensive Care Unit in Ujjain, India: A Prospective Cohort Study

et al. 2018

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Very little is known about laboratory-confirmed blood stream infections (LCBIs) in neonatal intensive care units (NICUs) in resource-limited settings. The aim of this cohort study was to determine the incidence, risk factors, and causative agents of LCBIs in a level-2 NICU in India. The diagnosis of LCBIs was established using the Centre for Disease Control, USA criteria. A predesigned questionnaire containing risk factors associated with LCBIs was filled-in. A total of 150 neonates (43% preterm) were included in the study. The overall incidence of LCBIs was 31%. The independent risk factors for LCBIs were: preterm neonates (relative risk (RR) 2.23), duration of NICU stay more than 14 days (RR 1.75), chorioamnionitis in the mother (RR 3.18), premature rupture of membrane in mothers (RR 2.32), neonate born through meconium-stained amniotic fluid (RR 2.32), malpresentation (RR 3.05), endotracheal intubation (RR 3.41), umbilical catheterization (RR 4.18), and ventilator-associated pneumonia (RR 3.17). The initiation of minimal enteral nutrition was protective from LCBIs (RR 0.22). The predominant causative organisms were gram-negative pathogens (58%). The results of the present study can be used to design and implement antibiotic stewardship policy and introduce interventions to reduce LCBIs in resource-limited settings.

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Early Total Enteral Feeding in Stable Very Low Birth Weight Infants: A Before and After Study

Abstract: In stable preterm VLBW infants, ETEF is safe and has the benefit of optimizing nutrition with decrease in sepsis, NEC and hospital stay.

Cited by 24 publications

References 21 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

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

Incidence and Determinants of Health Care-Associated Blood Stream Infection at a Neonatal Intensive Care Unit in Ujjain, India: A Prospective Cohort Study

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