Comparison of Feeding Regimens in Preterm Neonates with Abnormal Antenatal Doppler: A Randomized Controlled Trial

Anita Srinivasan; Ruchi N Nanavati; Nandkishor S Kabra.

Volume : VI, Issue : IV, April - 2017

Comparison of Feeding Regimens in Preterm Neonates with Abnormal Antenatal Doppler: A Randomized Controlled Trial

Anita Srinivasan, Ruchi N Nanavati, Nandkishor S Kabra.

Abstract :

Preterm neonates with abnormal antenatal doppler results in the form of absent or reversed end diastolic flow or cereal redistribution are at higher risk for the development of necrotizing enterocolitis due to impaired perfusion of the intestines in the initial few days. Hence the initiation of feeding is delayed, timing of starting feeds in these neonates according to protocols of various hospitals varies from first day to as long as one week, in order to reduce risk of NEC. Delay in initiation of feeds results in longer duration of parenteral nutrition and may increase incidence of sepsis related to intravenous access and perhaps increased duration of hospital stay. Early initiation of feeds is feared to increase incidence of NEC, but this risk should be balanced with the benefits of earlier time to full feeds and hospital discharge in case of early feeding. This trial was done to compare the safety and efficacy of early versus late initiation of enteral feeding in this special group of neonates.

Objectives: To evaluate the effects of an "early" enteral feeding regimen, starting milk feeds on day 2 after birth (between 24 and 48 hours of age) compared to one of "late" introduction of enteral feeds, starting feeds on day 6 after birth (between 120-143 hours of age) in a group of babies identified as being at high risk by antenatal Doppler studies.

Methods: This randomized, controlled, open, prospective, single-center clinical trial was conducted in a level III NICU in a tertiary hospital. 32 preterm infants ( less than 37 weeks of gestation) were randomized to early feeding (n=16) and late feeding (n=16).After stabilization and admission to NICU and before initiation of enteral feeding before 24 hours they were randomized to early feeding or late feeding group. Time taken to attain full feeds, incidence of NEC and occurrence of complications were noted in the patients.

Results: Time taken to achieve full enteral feeds in the early feeding group was 13.86 (SD=5.41) as compared to 15.92(SD=4.08) in the late feeding group (p=0.031). 1(6.25%) baby in the early feeding group developed NEC as compared to none in the late feeding group which was not statistically significant. The duration of iv fluid was significantly less in early feeding vs late feeding group (11.73�4.36 vs 15�2.89,P=0.038). The incidence of other complications did not show any significant difference between the early and late feeding group.

Conclusion: Early initiation of feeding did not result in increased incidence of NEC as compared to late feeding. Incidence of other complications did not differ significantly between the two groups. Time taken to achieve full feeds and duration of iv fluid were significantly reduced as compared to the late feeding group.