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The original ADEPT study, in which early versus late introduction of enteral feeds was compared in babies identified in-utero as having absent end-diastolic flow, showed that the earlier starters achieved full enteral feeds considerably sooner than the late starters, with no difference in rates of necrotising enterocolitis. Kempley and colleagues now report a more detailed analysis of the actual achieved rates of feed advancement in babies <29 weeks in ADEPT, from which it can be seen that these babies only tolerated very much slower feed increases than that suggested in the protocol. To put the achieved rate of advancement in perspective, in the first postnatal week it was only about a fifth of the rate specified in the ‘slow’ arm (18 mL/kg/day) of the current SIFT trial (HTA 11/01/25: Speed of Increasing milk Feeds Trial of rates of enteral feeding). See page F6
Antenatal steroids
One of the problems with randomised controlled trials is that just because a few extreme subjects are included, it does not follow that the overall benefits or harms demonstrated in the trial necessarily apply to such subjects. …
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