Oropharyngeal Administration of Mother's Milk Prior to Gavage Feeding in Preterm Infants: A Pilot Randomized Control Trial

Abstract

Background: Oropharyngeal administration of mother's colostrum in early days has an immunoprotective effect in preterm infants. Objectives: Our aim was to study the effect of oropharyngeal administration of mother's milk (OPAMM) on decreasing the incidence of nosocomial sepsis. Methods: In a pilot prospective randomized study on preterm (<32 weeks gestation and 1500 g weight) infants, we compared OPAMM practice (applying 0.2 mL of mother's colostrum or milk prior to gavage feeding until full oral feeding is reached) with regular gavage feeding. The primary outcome was incidence of culture-proven nosocomial sepsis. Secondary outcomes included bacterial colonization of the gastrointestinal tract, feeding intolerance, time to reach full feeding, incidence of necrotizing enterocolitis, ventilator-associated pneumonia, duration of respiratory support, incidence of bronchopulmonary dysplasia (BPD), length of hospital stay, and neonatal mortality. Results: The outcomes of 200 neonates (100 in each group) were analyzed. OPAMM practice did not significantly reduce the incidence of culture proven nosocomial sepsis (8% vs 13%, P = 0.35). Infants in the OPAMM group had a significantly lower growth of Klebsiella species in the oropharyngeal pouch, borderline lower incidence of ventilator-associated pneumonia, shorter duration of oxygen therapy, less episodes of feeding intolerance, reached full feeding earlier, and had a shorter length of hospital stay. OPAMM practice did not affect the incidence of necrotizing enterocolitis, BPD, or neonatal mortality. Conclusion: OPAMM prior to gavage feeding does not reduce the incidence of nosocomial sepsis but had beneficial effects on early achievement of feeding, and early hospital discharge in preterm very low-birth-weight infants. (JPEN J Parenter Enteral Nutr. 2020;44:92-104) Clinical Relevancy StatementGavage feeding in preterm infants deprives the oropharyngeal pouch from the beneficial effect of mother's colostrum and milk. Previous reports have shown immunoprotective and anti-inflammatory effects for mother's colostrum when given early to the oropharyngeal pouch. We found that oropharyngeal administration of mother's milk prior to gavage feeding was associated with shorter duration to achieve full feeding, duration of oxygen support, and length of hospital stay in preterm infants.From the

Effects of oropharyngeal administration of colostrum on the incidence of necrotizing enterocolitis, late-onset sepsis, and death in preterm infants: a meta-analysis of RCTs

“…Methodological weaknesses existed for most of the included studies. Six studies [17,18,22,23,33,34] had a low ROB in random sequence generation, with one study [35] reported a high risk and two [36,37] reported an unclear risk. Allocation concealment was of high risk in one study [35] and of unclear risk in three studies [17,18,37].…”

“…After eliminating the studies of Zhang et al [23], Glass et al [18], and Romano-Keeler et al [35] for the all-cause mortality rate, six studies [17,22,33,34,36,37], with a total sample of 505 preterm infants were included to measure the mortality rate (Fig. 3c).…”

“…Duration of hospital stay was reported in five studies [17,22,33,34,37], while two studies [17,34] were excluded; thus, three studies [22,33,37], with a sample of 332 preterm infants, were included (Fig. 4b).…”

“…and the nutrition outcomes (weight at discharge, day feedings initiation, etc.) were measured [22]. Abd-Elgawad et al found that OAC could shorten the duration of hospital stays and meet the early achievement of feeding, albeit without any decline in the incidence of NEC [22].…”

“…were measured [22]. Abd-Elgawad et al found that OAC could shorten the duration of hospital stays and meet the early achievement of feeding, albeit without any decline in the incidence of NEC [22]. However, Zhang et al have discovered that OAC has potential protection on NEC with statistical significance showing [23].…”