Incidence, Clinical Signs and Co-morbidities of Feeding Intolerance among Preterm Infants Aged 28-34 Weeks of Gestation in a Tertiary Care Hospital of Western Nepal- A Prospective Observational Study

Abstract

Introduction: Feeding intolerance is common among the preterm neonates and is associated with different co-morbidities like respiratory depression, respiratory distress syndrome, apnea, hyperbilirubinaemia, and hypoxic ischaemic encephalopathy. Aim: To find the incidence of feeding intolerance in preterm neonates from 28-34 weeks of gestation along with the clinical signs and co-morbidities associated with feeding intolerance. Materials and Methods: A prospective observational hospital based study was conducted in Neonatal Intensive Care Unit (NICU) and postnatal ward of Universal College of Medical Sciences, a tertiary care hospital situated in western Nepal for 12 months (June 2018 to May 2019). All admitted preterm neonates between 28-34 weeks of gestation were included in the study and were followed-up for any neonatal morbidities along with feeding intolerance. Feeding intolerance was defined when the newborn had vomiting and/or abdominal distension and/or increased gastric residual volume with normal disruption of feeding process. Babies with feeding intolerance were subjected to final analysis for clinical signs and co-morbidities. Results: Out of 490 admitted preterm babies (28-34 weeks), 54 (11.02%) had feeding intolerance with 33 (61.1%) babies in the very low birth weight group. The mean birth weights of the total enrolled babies (n=490) and feed intolerant (n=54) babies were 1550 gm and 1418 gm, respectively. Different co- morbidities associated with feeding intolerance were respiratory distress (25.9%), respiratory distress syndrome (22.2%), jaundice (16.7%), apnea (5.6%) and necrotising enterocolitis (3.7%). Among the total 37 preterm deaths, four babies were in the feeding intolerance group. Majority of all feed intolerant babies had vomiting 49 (90.7%) followed by gastric residue (57.4%), abdominal distension (55.6%), and reduced or absent bowel sounds (7.4%), respectively. The incidence of feeding intolerance was increased in babies fed with formula feed (p=0.46) and when feeding was started <24 hours (p=0.22) but the results were statistically insignificant. Conclusion: The incidence of feeding intolerance was 11.02% in the preterm neonates (28-34 weeks) with high proportion in very low birth weight babies. Vomiting, gastric residue and abdominal distension were three important signs of feeding intolerance in newborns.

Feeding Intolerance among Preterm Neonates Admitted to the Neonatal Intensive Care Unit at a Tertiary Care Centre: A Descriptive Cross-sectional Study

“… 7 The incidence of feeding intolerance also varied greatly in different studies done in different geographical areas, 4.2% in Dhaka, 36% in Bangladesh, 2.6% in Egypt, 34% in African Israelian and 15% in other Israelian, 11.02% in Western Nepal. 2 , 6 - 10 The prevalence of feeding intolerance in this study was found to be 38.18% which is almost similar to a study done in Bangladesh, 8 but higher than another Bangladeshi study. 2 Here, the majority of preterm with feeding intolerance had features of, abdominal distension (47.6%) and some had apnea (23.8%), gastric residual 14.3%, and vomiting (14.3%).…”

“…Free Full Text Articles are Available at www.jnma.com.np Israelian, 11.02% in Western Nepal. 2,[6][7][8][9][10] The prevalence of feeding intolerance in this study was found to be 38.18% which is almost similar to a study done in Bangladesh, 8 but higher than another Bangladeshi study. 2 Here, the majority of preterm with feeding intolerance had features of, abdominal distension (47.6%) and some had apnea (23.8%), gastric residual 14.3%, and vomiting (14.3%).…”

“…Similar to ours, another study also detected HMD as the most common morbidity (23.7%), in preterm with feed intolerance. 6 In our observation most preterm neonates admitted to NICU (87.27%) started with expressed breast milk and the remaining (0.12%) were given formula milk. The World Health Organisation recommends the use of donor human milk (DHM) as a lifesaving alternative, especially for vulnerable, low birth weight, and preterm neonates.…”

“…But unlike this study, in Western Nepal, 90.7% of all feed intolerant babies had vomiting followed by gastric residue, abdominal distension, reduced or absent bowel sounds and apnea respectively. 6 Most of the other studies also had similar clinical presentations of vomiting, abdominal distension, gastric residual, and apnea. 2 , 7 In this study, as regards the presence of other morbidities in the cases with feeding intolerance, it was HMD (33.3%) followed by sepsis (19%), and pneumonia (14.3%).…”

“…Similar to ours, another study also detected HMD as the most common morbidity (23.7%), in preterm with feed intolerance. 6 …”