High versus standard volume enteral feeds to promote growth in preterm or low birth weight infants

Abiramalatha, Thangaraj; Thomas, Niranjan; Thanigainathan, Sivam

doi:10.1002/14651858.cd012413.pub3

Cited by 13 publications

(11 citation statements)

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“…This may reflect the length of time needed for research findings to be incorporated into clinical guidelines and routine practice, the first publication dating from 2009 ( 26 ). Most units started enteral feeding with trophic feeds ranging between 10 and 20 ml/kg/day, with daily advancements of 10–20 ml/kg/day, though there is evidence from developed countries that faster advancement of 30–40 ml/kg/day may be safe and facilitates earlier attainment of full enteral feeds ( 8 , 27 ) few of the units in this survey advanced more than 20 ml/kg/day. The WHO feeding guidelines for preterm infants recommend a daily increase “up to” 30 ml/kg for LMICs ( 14 ) and this may be the reason for the observed practice.…”

Section: Discussionmentioning

confidence: 84%

“…Optimizing early nutrition in very preterm and VLBW neonates has the potential to improve their survival, growth, neurodevelopment, and long-term health outcomes. Early feeding strategies for preterm infants vary widely across the world and, although optimal postnatal growth rates have not been established, there is a general consensus to aim for a gestation-equivalent fetal growth rate ( 8 ). Noteworthy is that preterm infants have higher nutritional requirements than term infants.…”

Section: Introductionmentioning

confidence: 99%

“…To achieve this, an energy intake of 110 to 135 Kcal/kg/day and protein intake of 3.5 to 4 g/kg/day in VLBW infants is recommended ( 9 ). Failure to meet recommended nutrient intakes results in poor growth and is associated with increased short-term risks such as LOS and predisposes them to long-term neurodevelopmental impairment and adult onset metabolic and cardiovascular disease ( 8 , 10 – 12 ).…”

Section: Introductionmentioning

confidence: 99%

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Enteral Feeding Practices for Very Preterm and Very Low Birth Weight Infants in Nigeria and Kenya

et al. 2022

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Background:Optimizing nutrition in very preterm (28–32 weeks gestation) and very low birth weight (VLBW; 1,000 g to <1,500 g) infants has potential to improve their survival, growth, and long-term health outcomes.AimTo assess feeding practices in Nigeria and Kenya for very preterm and VLBW newborn infants.MethodsThis was a cross-sectional study where convenience sampling was used. A standard questionnaire was sent to doctors working in neonatal units in Nigeria and Kenya.ResultsOf 50 respondents, 37 (74.0%) were from Nigeria and 13 (26.0%) from Kenya. All initiated enteral feeds with breastmilk, with 24 (48.0%) initiating within 24 h. Only 28 (56.0%) used written feeding guidelines. Starting volumes ranged between 10 and 80 ml/kg/day. Median volume advancement of feeds was 20 ml/kg/day (IQR 10–20) with infants reaching full feeds in 8 days (IQR 6–12). 26 (52.0%) of the units fed the infants 2 hourly. Breastmilk fortification was practiced in 7 (14.0%) units, while folate, iron, calcium, and phosphorus were prescribed in 42 (84.0%), 36 (72.0%), 22 (44.0%), 5 (10.0%) of these units, respectively. No unit had access to donor breastmilk, and only 18 (36.0%) had storage facilities for expressed breastmilk. Twelve (24.0%) used wet nurses whilst 30 (60.0%) used formula feeds.ConclusionFeeding practices for very preterm and VLBW infants vary widely within Nigeria and Kenya, likely because of lack of locally generated evidence. High quality research that informs the feeding of these infants in the context of limited human resources, technology, and consumables, is urgently needed.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Enteral Feeding Practices for Very Preterm and Very Low Birth Weight Infants in Nigeria and Kenya

et al. 2022

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“…We do not administer parenteral fluids unless the patient cannot tolerate the oral feeds, or it is necessary to administer medications or has another serious pathology requiring fluids. From there, we continue to increase the volume by 5 mL every 12-24 hours until the baby can tolerate 200 mL/Kg, [9][10][11] by the third day ideally with fortified breast milk as soon as it is available (we don´t have bank human milk). The present study sought to compare cases before and after this new policy, to see if it had had any beneficial or adverse results.…”

Section: Introductionmentioning

confidence: 99%

Decrease in the Use of Parenteral Fluids in Premature Infants from 30 to 34 Weeks of Gestation at Birth

Hoyos¹,

Vásquez‐Hoyos²

2022

Preprint

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Introduction: Some of the practices in medicine are carried out of habit without proven benefits. This is the case of premature babies from 30 to 34 weeks of gestation who are always given parenteral fluids, even though this practice has been associated with an increase incidence of infection. At the end of 2017, we started a protocol of rationalization in the use of parenteral fluid. To administer nutrition/fluids, we used oral fluids by suction if this was possible or otherwise by oral/nasogastric tube at volumes of 70-80 mL/Kg/day divided every 3 hours, with 5 mL increments every 12-24 hours until 200 mL/K/day was achieved, always using breast milk when possible. Material and methods: The present study sought to compare results before and after this new policy. For this work, we review all premature babies between 30-34 weeks of gestation in two time periods, the first from 01/01/2010 to 12/31/2017 and the second from 01/01/2018 to 08/15/2022. The number of cases with and without parenteral fluids (PF), the incidence of infection, the weight at admission and discharge, and the change in the weight Z score between birth and discharge were compared. Both the anthropometric and outcome variables were compared using the different statistical methods according to each variable. Results: were found 920 cases with the described characteristics. The groups before and after the intervention did not show significant differences in their general demographic characteristics. We observed a decrease use of PF in the second period, from 425 cases (82.0%) before to 297 (26.2%) after implementation, p <0.0001 and fewer days of use (4.1 days/average before vs 1.3 after, p <0.0001) of PF. The weight at discharge and the change in weight Z-score were the same in both groups. Infections went from nine cases before to two cases after but it was not statistically significant. There were no complications due to less use of PF. Discussion: This study showed that the use of PF is not associated with significant changes in outcomes of interest, which reinforces that its use does not generate any benefit for the patient. Larger number of cases is required to detect differences in low incidence events such as infections.

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“…We do not administer parenteral fluids unless the patient cannot tolerate the oral feeds or it is necessary to administer medications or has another serious pathology requiring fluids. From there, we continue to increase the volume by 5 mL every 12-24 hours until the baby can tolerate 200 mL/Kg, [8][9][10] by the third day ideally with fortified breast milk as soon as it is available (we don´t have bank human milk). The present study sought to compare cases before and after this new policy, to see if it had had any beneficial or adverse results.…”

Section: Introductionmentioning

confidence: 99%

Decrease in the Use of Parenteral Fluids in Premature Infants from 31 to 34 Weeks of Gestation at Birth

Hoyos¹,

Vásquez‐Hoyos²

2021

Preprint

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Introduction: Some of the practices in medicine are carried out of habit without proven benefits. This is the case of premature babies from 31 to 34 weeks of gestation who are always given parenteral fluids, even though this practice has been associated with an increase incidence of infection. In 2017, we started a protocol of parenteral fluid restriction. To administer nutrition/fluids, we used oral fluids by suction if this was possible or otherwise by oral/nasogastric tube at volumes of 15-20 mL intake every 3 hours, with 5 mL increments every 12-24 hours until 200 mL/K/day was achieved, always using breast milk when possible.Material and methods: The present study sought to compare cases before and after this new policy. For this work, we review all premature babies between 31-34 weeks of gestation discharged home in two periods of time, the first from 01/01/2012 to 12/31/2017 and the second from 01/01/2018 to 08/31/2021. The number of cases with and without parenteral fluids (PF), the incidence of infection, the weight at admission and discharge, and the fall in the weight Z score between birth and discharge were compared. Both the anthropometric and outcome variables were compared using the different statistical methods according to each variable.Results: 725 cases were found with the described characteristics. The groups before and after the intervention did not show significant differences in their general demographic characteristics. A lower use of PF was observed in the second period from 348 cases (79%) to 70 (24%), p <0.001 and fewer days of use (4.1 days/case vs 1.3, p <0.0001) of PF. The weight at discharge and the change in weight Z-score were the same in both groups. Infections went from three cases to zero but it was not statistically significant. There were no complications due to less use of PF.Discussion: This study showed that the use of PF is not associated with significant changes in outcomes of interest, which reinforces that its use does not generate any benefit for the patient. Larger number of cases is required to detect differences in low incidence events such as infections.

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High versus standard volume enteral feeds to promote growth in preterm or low birth weight infants

Abstract: High versus standard volume enteral feeds to promote growth in preterm or low birth weight infants. Cochrane Database of Systematic Reviews. CD012413.

Cited by 13 publications

References 50 publications

Enteral Feeding Practices for Very Preterm and Very Low Birth Weight Infants in Nigeria and Kenya

Enteral Feeding Practices for Very Preterm and Very Low Birth Weight Infants in Nigeria and Kenya

Decrease in the Use of Parenteral Fluids in Premature Infants from 30 to 34 Weeks of Gestation at Birth

Decrease in the Use of Parenteral Fluids in Premature Infants from 31 to 34 Weeks of Gestation at Birth

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