Effect of Feeding Schedule on Time to Reach Full Feeds in ELBW and VLBW Neonates: A Randomized Trial

Showkat Hussain Tali, Nandkishor Shrikishanji Kabra, Javed Ahmed, Swarup Kumar Dash, Haribalkrishna Balasubramanian, Bhupendra Suryanarayan Avasthi, Shobha Rajesh Sharma

Abstract

Aim: To compare the effect of 3-hourly (3-h) versus 2-hourly (2-h) feeding schedules on time to reach full feeds in neonates weighing ≤ 1500 g

Materials and Methods: This was a randomized trial conducted in a level 3 neonatal intensive care unit (NICU), Department of Neonatology, Surya Child Care (Mumbai, Maharashtra, India). We enrolled 120 preterm neonates with birth weights of 501 to 1500 g. The neonates were divided into 2 strata based on birth weight: 501 to 1000 g and 1001 to 1500 g.

The neonates were randomized into 2 orogastric feeding schedules: 8 or 12 feeds (3-h or 2-h schedules, depending upon randomization), and a uniform feeding protocol was followed. 

Analysis was performed using the intention-to-treat principle. Categorical variables were compared using the Chi-square test. Continuous measures between groups were compared using 2-sample t test or Mann–Whitney U test as appropriate. Data were analyzed using IBM SPSS version 21 software. P < .05 was considered significant. 

Primary outcome measures were time (in days) to reach full feeds (defined as tolerance of 150 mL/kg/d of feeds for at least 48 h).

Secondary outcome measures were time (in days) to attain birth weight; time (in days) to discharge; weight, length, and head circumference at discharge; incidence of feed intolerance, necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), screen-positive sepsis, culture-positive sepsis, hypoglycemia, apnea, jaundice, and retinopathy of prematurity (ROP); duration of total parenteral nutrition (TPN) and nursing; and mortality.

Results: A total of 215 neonates were assessed for eligibility, of whom 95 were excluded. Hence, 120 neonates were enrolled in the trial. There was no significant difference in time (in days) to reach full feeds in the 2-h versus 3-h groups (9.53 ± 4.26 vs 9.85 ± 5.48; P = .73). There was no significant difference between the 2 groups in any of the secondary outcomes such as time to attain birth weight; time to discharge; anthropometric parameters at discharge; feed intolerance; use of metoclopramide and mosapride; and incidence of NEC, IVH, ROP, and sepsis. The total time spent per day in feeding was significantly lesser in the 3-h feeding schedule groups (P = .04). 

Subgroup analysis revealed that among the neonates in the lower birth weight strata (501 to ≤ 1000 g), those fed 2-h reached full feeds earlier compared with those fed 3-h (2-h group: 11.24 ± 2.88 d vs 3-h group: 14.14 ± 4.98 d; P = .041).

Conclusions: There was no significant difference in time to reach full feeds in all the neonates, irrespective of whether they were fed 2-h or 3-h. However, neonates < 1000 g reached full feeds earlier when fed more frequently (2-h feeding schedule).

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