A national survey of the enteral feeding practices in Canadian neonatal intensive care units

Abstract

Aim Nutrition affects the growth and neurodevelopmental outcomes of preterm infants, yet controversies exist about the optimal enteral feeding regime. The objective of this study was to compare enteral feeding guidelines in Canadian neonatal intensive care units (NICUs). Method The research team identified key enteral feeding practices of interest. Canadian Neonatal Network site investigators at 30 Level 3 NICUs were contacted to obtain a copy of their 2016 to 2017 feeding guidelines for infants who weighed less than 1,500 g at birth. Each guideline was reviewed to compare recommendations around the selected feeding practices. Results Five of the 30 NICUs did not have a feeding guideline. The other 25 NICUs used 22 different enteral feeding guidelines. The guidelines in 40% of those NICUs recommend commencing minimal enteral nutrition (MEN) within 24 hours of birth and maintaining that same feeding volume for 24 to 96 hours. In 40% of NICUs, the guideline recommended that MEN be initiated at a volume of 5 to 10 mL/kg/day for infants born at <1,000 g. Guidelines in all 25 NICUs recommend the use of bovine-based human milk fortifier (HMF), and in 56% of NICUs, it is recommended that HMF be initiated at a total fluid intake of 100 mL/kg/day. Guidelines in only 16% of NICUs recommended routine gastric residual checks. Donor milk and probiotics are used in 76% and 72% of the 25 NICUs, respectively. Conclusion This study revealed substantial variability in recommended feeding practices for very low birth weight infants, underscoring the need to establish a national feeding guideline for this vulnerable group.

Feeding premature babies in the neonatology department of the Androva Mahajanga Hospital

“…This is linked to the immaturity of the gastrointestinal tract. 2 The hospital prevalence of ulcerative colitis was 9.5%, and although high, it was lower than that found in Ethiopia (25.4%). 8 The average daily weight gain was 9.28 g/kg/d, close to that found in a study by Faye et al (7.8 g/kg/d).…”

“…3 The exact age at which enteral feeding should be introduced is not clearly defined, but it would be advisable to initiate it within the first 24 hours of life, up to the 72nd hour, and if possible, if the newborn's condition allows, within the first six hours of life. 2 Starting enteral feeding as early as possible would prevent intestinal villous atrophy, favorably influence the intestinal microbiome, reduce the risk of developing systemic inflammation, and decrease the risk of developing comorbidities such as retinopathy of prematurity and bronchopulmonary dysplasia. 4 On average, the initial amount administered was 28.4ml/kg/d.…”

“…It would be best to start enteral feeding with breast milk, the second option is milk from a milk donor; and preterm formulas should only be given if these two options are not available. 2 Several biological factors present in breast milk are absorbed by the digestive tract, and promote maturation, play an anti-inflammatory and barrier role. 7 The use of breast milk reduces the risk of ulcerative colitis.…”

“…Premature infants have a very high nutritional requirement in the neonatal period, in order to cover their basic metabolic needs and achieve satisfactory growth. 1,2 Enteral feeding is ideal, as it stimulates the development of the gastrointestinal mucosa, intestinal motility and enzyme synthesis, and reduces the risk of sepsis due to bacterial translocation. However, the initiation and progression of enteral feeding in preterm infants remains a challenge due to acute illnesses in the early neonatal period and functional immaturity of the gastrointestinal tract, which can lead to food intolerance or ulcerative colitis.…”

“…However, the initiation and progression of enteral feeding in preterm infants remains a challenge due to acute illnesses in the early neonatal period and functional immaturity of the gastrointestinal tract, which can lead to food intolerance or ulcerative colitis. 2,3 The aim of our study was to evalue the enteral nutritional management of premature infants in the neonatology department of the Androva Mahajanga mother-child complex.…”