Randomized, Controlled Trial of Slow Versus Rapid Feeding Volume Advancement in Preterm Infants

Caple, Judith; Armentrout, Debra; Huseby, Valerie; Halbardier, Brenda; Garcia, Jose; Sparks, John W.; Moya, Fernando

doi:10.1542/peds.2004-1232

Cited by 91 publications

(84 citation statements)

References 20 publications

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“…feedings, using feeding guidelines, have been implemented and these too have been shown to improve weight gain. [13][14][15][16][17][18] We recognize that our new weight grid does not display 'ideal' weight changes, but it displays actual changes, using a large cohort of heterogeneous low birth weight (LBW) NICU patients in four different hospitals. The lack of initial weight loss we observed among the smallest neonates was not seen in the previous growth grids.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] On the basis of these, we hypothesized that NICU patients cared for currently have more rapid weight gain than are displayed on the commonly used postnatal grids. [2][3][4][5] To test this we collected, from electronic records, all daily weights of all patients with birth weights 400-2600 g, born during a 30-month period, January 1, 2003-June 30, 2005, cared for in any the NICU's of the Intermountain Health Care (IHC) System.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pattern of daily weights among low birth weight neonates in the neonatal intensive care unit: data from a multihospital health-care system

et al. 2005

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pattern of daily weights among low birth weight neonates in the neonatal intensive care unit: data from a multihospital health-care system

et al. 2005

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“…Four prior randomized trials found that more rapidly advancing feeding regimens in premature infants resulted in more rapid attainment of birth weight and shorter time to full feedings without increasing the incidence of NEC. [21][22][23][24] A case-control study found that infants who developed sepsis had feedings initiated later than infants who did not, but that infants who developed NEC were fed at the same age (3 to 4 days) as infants who did not. 25 In contrast, a randomized trial, comparing rapid vs slow advancement of feeding was discontinued early because of an increase in NEC in the rapid advancing group.…”

Section: Feeding Issuesmentioning

confidence: 99%

Clinical parameters do not adequately predict outcome in necrotizing enterocolitis: a multi-institutional study

et al. 2008

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Objective: Necrotizing enterocolitis (NEC) remains a major cause of neonatal morbidity and mortality. Some infants recover uneventfully with medical therapy whereas others develop severe disease (that is, NEC requiring surgery or resulting in death). Repeated attempts to identify clinical parameters that would reliably identify infants with NEC most likely to progress to severe disease have been unsuccessful. We hypothesized that comprehensive prospective data collection at multiple centers would allow us to develop a model which would identify those babies at risk for progressive NEC.Study Design: This prospective, observational study was conducted at six university children's hospitals. Study subjects were neonates with suspected or confirmed NEC. Comprehensive maternal and newborn histories were collected at the time of enrollment, and newborn clinical data were collected prospectively, thereafter. Multivariate logistic regression analysis was used to develop a predictive model of risk factors for progression.Result: Of 455 neonates analyzed, 192 (42%) progressed to severe disease, and 263 (58%) advanced to full feedings without operation. The vast majority of the variables studied proved not to be associated with progression to severe disease. A total of 12 independent predictors for progression were identified, including only 3 not previously described: having a teenaged mother (odds ratio, OR, 3.14; 95% confidence interval, CI, 1.45 to 6.96), receiving cardiac compressions and/or resuscitative drugs at birth (OR, 2.51; 95% CI, 1.17 to 5.48), and having never received enteral feeding before diagnosis (OR, 2.41; 95% CI, 1.08 to 5.52). Conclusion:Our hypothesis proved false. Rigorous prospective data collection of a sufficient number of patients did not allow us to create a model sufficiently predictive of progressive NEC to be clinically useful. It appears increasingly likely that further analysis of clinical parameters alone will not lead to a significant improvement in our understanding of NEC. We believe that future studies must focus on advanced biologic parameters in conjunction with clinical findings.

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“…[1][2][3][4][5][6][7][8] Little evidence is available to guide these decisions, especially about feeding interval. Several small studies and a systematic review suggest that intermittent bolus feedingsFcompared with continuous feedingsFimprove feeding tolerance and growth in VLBW infants.…”

Section: Introductionmentioning

confidence: 99%

The impact of feeding interval on feeding outcomes in very low birth-weight infants

2011

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Objective: Test the hypothesis that very low birth-weight (VLBW) infants fed every 2 h (q2) are able to reach full enteral feedings more quickly than infants fed every 3 h (q3).Study Design: We performed a retrospective cohort study comparing q2 infants (n ¼ 103) with q3 infants (n ¼ 251). The primary outcome was days from start of a feeding advance to full feedings (120 ml per kg per day). Multivariable regression models were used to control for maternal and perinatal factors that preceded the initiation of the feeding advance.Result: Infants fed q2 reached full feedings 2.7 days sooner than q3 infants (95% confidence interval (CI) 1.5, 3.9). After adjustment for confounders, q2 infants reached full feedings 3.7 (95% CI 1.6, 5.9) days more quickly. Infants fed q3 were more likely to receive >28 days of parenteral nutrition (odds ratio (OR) 4.7; 95% CI 1.5, 14.4), and were more likely to have feeds held for X7 days (OR 4.7, 95% CI 1.9, 11.7).Conclusion: VLBW infants demonstrate improved feeding tolerance when fed more frequently.

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Randomized, Controlled Trial of Slow Versus Rapid Feeding Volume Advancement in Preterm Infants

Cited by 91 publications

References 20 publications

Pattern of daily weights among low birth weight neonates in the neonatal intensive care unit: data from a multihospital health-care system

Pattern of daily weights among low birth weight neonates in the neonatal intensive care unit: data from a multihospital health-care system

Clinical parameters do not adequately predict outcome in necrotizing enterocolitis: a multi-institutional study

The impact of feeding interval on feeding outcomes in very low birth-weight infants

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