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Feeding infants below 29 weeks’ gestation with abnormal antenatal Doppler: analysis from a randomised trial
  1. Stephen Kempley1,
  2. Neelam Gupta2,
  3. Louise Linsell3,
  4. Jon Dorling4,
  5. Kenny McCormick2,
  6. Paul Mannix5,
  7. Edmund Juszczak3,
  8. Peter Brocklehurst3,6,
  9. Alison Leaf7,
  10. on behalf of the ADEPT Trial Collaborative Group
  1. 1Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  2. 2Neonatal Unit, John Radcliffe Hospital, Oxford, UK
  3. 3National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
  4. 4Academic Division of Child Health, University of Nottingham, Nottingham, UK
  5. 5Southmead Hospital, Bristol, UK
  6. 6Institute for Women's Health, University College, London, UK
  7. 7NIHR Southampton Biomedical Research Centre, Southampton University Hospitals NHS Foundation Trust, Southampton, UK
  1. Correspondence to Dr Stephen Kempley, Centre for Paediatrics, Blizard Institute, Barts and the London School of Medicine and Dentistry, 4 Newark Street, London E1 2AT, UK; s.t.kempley{at}qmul.ac.uk

Abstract

Objective To describe feeding and gastrointestinal outcomes in growth-restricted infants <29 weeks’ gestation and to determine the rate of feed advancement which they tolerate.

Design Analysis of prospectively collected data from a randomised feeding trial, the Abnormal Doppler Enteral Prescription Trial (ADEPT).

Setting 54 neonatal units in the UK and Ireland.

Participants 404 preterm, growth-restricted infants with abnormal antenatal Doppler studies from ADEPT. 83 infants <29 weeks and 312 infants ≥29 weeks’ gestation were included in this analysis.

Interventions In ADEPT, infants were randomised to start milk ‘early’ on day 2 after birth, or ‘late’ on day 6. Subsequent feed advancement followed a regimen, which should have achieved full feeds by day 16 in the early and day 20 in the late group.

Main outcome measures Full feeds were achieved later in infants <29 weeks; median age 28 days {IQR 22–40} compared with 19 days {IQR 17–23} in infants ≥29 weeks (HR 0.35, 95% CI 0.3 to 0.5). The incidence of necrotising enterocolitis was also higher in this group; 32/83 (39%) compared to 32/312 (10%) in those ≥29 weeks (RR 3.7, 95% CI 2.4 to 5.7). Infants <29 weeks tolerated very little milk for the first 10 days of life and reached full feeds 9 days later than predicted from the trial regimen.

Conclusions Growth-restricted infants born <29 weeks’ gestation with abnormal antenatal Doppler failed to tolerate even the careful feeding regimen of ADEPT. A slower advancement of feeds may be required for these infants.

Trial registration number ISRCTN87351483.

  • Neonatology
  • Gastroenterology
  • Nutrition
  • Fetal Medicine

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