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Analysis of feeding intolerance in growth restricted <29weeks infants

Presented at the Neonatal Society 2010 Autumn Meeting.

Gupta N1, Kempley S2 on behalf of the ADEPT study group

1 John Radcliffe Hospital & NPEU, Oxford, UK
2 Barts and the London School of Medicine and Dentistry, London, UK

Background: Feeding the preterm growth restricted (neonate) infant remains a big challenge, with both parenteral and enteral nutrition support required to achieve reasonable growth rates. The duration of minimal enteral nutrition and subsequent rate of advancement is an area of uncertainty. The aim of this study was to determine patterns of feeding tolerance in growth restricted preterm infants of <29 weeks gestation and to determine the rate of advancement of feeds which these infants tolerate. Informed parental consent was obtained for all patients; the study had full MREC approval.

Methods: We utilised the data from 54 neonatal units which participated in the UK multicentre randomised control Abnormal Doppler Enteral Prescription Trial (ADEPT). 404 preterm, small-for-gestational age infants with abnormal antenatal Doppler findings were randomised to early (commencing feeds at 24-48 hours) or late introduction (commencing feeds at 120-144 hours) of enteral feeding. Of these 404 infants, 82 infants who were <29 weeks were selected for this subgroup analysis. Feeding intolerance was pre- defined and feed volume due to intolerance was altered or stopped at local clinician’s discretion.

Results: In keeping with the main study group, infants <29 weeks were well matched between early and late feeding groups for major parameters such as gestation and birthweight. Both groups started TPN at a median age of 2 days and had central lines in place for an average of 18 days.

Median number of days of feed intolerance was 7 days in both groups, The early feeding group had significantly more frequent episodes of intolerance compared to the late group. Factors significantly associated with days of feeding intolerance were birth weight < 600gram, late passage of meconium (> 72 hrs) and cholestasis. The median volume of feeds on first day of feeding intolerance was similar in both groups and was at volumes of 9mls/kg/day.

The median volume of feeds tolerated by infants in the first 10 day of life was much lower than the target volume in this trial. This intolerance of feeds in early days of life was present in both early and late feeding group.

Conclusion: Growth restricted babies of <29 weeks gestation with abnormal antenatal Dopplers failed to tolerate even the careful graded feeding regime used in the ADEPT study. This cohort of babies may require an increased duration of minimal enteral feeds and slower advancement of feeds to decrease intolerances and establish full feeds. In this group, predictive markers to recognise the babies at increased risk of feeding intolerance were birth weight < 600gram and late passage of stool (>72hrs).

Corresponding author: neelam27@doctors.org.uk

Jadcherla SR and Kliegman RM. Studies of Feeding Intolerance in Very Low Birth weight Infants: Definition and Significance. Pediatrics 2002; 109; 516-517. Mihatsch WA, Pohlandt F, Franz AR, Flock F. Early feeding advancement in very low-birth-weight infants with intrauterine growth retardation and increased umbilical artery resistance. J Pediatr Gastroenterol Nutr 2002; 35:144-8.

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