Presented at the Neonatal Society 2003 Autumn Meeting.
Boyle EM1, Menon G1, Elton R2, N McIntosh1 (introduced by Neil McIntosh)
1Neonatal Unit, Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Little France, Edinburgh
2Department of Public Health Sciences, University of Edinburgh, Edinburgh
Background: Enteral feeding of preterm and low birth weight infants is a contentious area of clinical practice. Opinion about optimum feeding regimens differs considerably and it is likely that variation in clinical practice is wide. There is a need for large randomised controlled trials to define optimum feeding strategies for infants feeding. Documentation of the range of practice, including any extremes, is helpful for planning such studies.
Aim: To discover the range of clinical practice for initiation and progression of enteral feeds in preterm and very low birth weight infants in Scotland.
Methods: Medical and nursing records of neonates <=32 weeks’ gestation and/or <=1500g birth weight were reviewed retrospectively. The period of time examined was from birth until 14 days after the attainment of full enteral feeds. Data were collected on the introduction of enteral feeds, progression to full feeds and temporary discontinuation of feeds.
Results: Records of 81 infants, who were inpatients in 14 Scottish neonatal units, were examined in July 2003. Their median (range) birth weight and gestational age were 1080 (575 – 2230) g and 29 (24 – 32) weeks respectively. Most (69%) babies received maternal breast milk. The remaining infants received term (10%), preterm (11%) or hydrolysed protein (10%) formula. The median (range) time of introduction of milk feeds was day 3 (1 – 24) of life and time to attain full enteral feeding was 11 (4 – 55) days; one-way analysis of variance showed that the differences between centres were highly significant for both (P < 0.001). The median (range) number of hours where feeds were stopped during the progression to full feed volumes was 10 (0 – 648) hours. Analysis using the Kruskal – Wallis test confirmed significant inter-unit variation (P = 0.044). 8 of the 81 infants (9.9%) in the group were treated for definite necrotising enterocolitis, with 2 requiring surgical intervention. A further 3 (3.7%) received some treatment for suspected bowel pathology. The effects of centre remained highly significant after adjustment for gestation and birth weight and were still present after exclusion of infants with proven or suspected gut pathology.
Conclusions: The survey confirms considerable disparity in current feeding practice in neonatal units in Scotland. Differences were observed with respect to type of milk used, timing of introduction of enteral feeds, speed of feed advancement and temporary discontinuation of feeds. Although many differences in clinical practice are dependent on the gestational age and weight of infants, it appears that the observed variation in feeding practice between neonatal units is not fully explained by case mix and may be more related to differences in policy or individual practice.