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Abstract
AIMS To determine the effect of trophic feeding on clinical outcome in ill preterm infants.
METHODS A randomised, controlled, prospective study of 100 preterm infants, weighing less than 1750 g at birth and requiring ventilatory support and parenteral nutrition, was performed. Group TF (48 infants) received trophic feeding from day 3 (0.5–1 ml/h) along with parenteral nutrition until ventilatory support finished. Group C (52 infants) received parenteral nutrition alone. “Nutritive” milk feeding was then introduced to both groups. Clinical outcomes measured included total energy intake and growth over the first six postnatal weeks, sepsis incidence, liver function, milk tolerance, duration of respiratory support, duration of hospital stay and complication incidence.
RESULTS Groups were well matched for birthweight, gestation and CRIB scores. Infants in group TF had significantly greater energy intake, mean difference 41.4 (95% confidence interval 9, 73.7) kcal/kg p=0.02; weight gain, 130 (CI 1, 250) g p = 0.02; head circumference gain, mean difference 0.7 (CI 0.1, 1.3) cm, p = 0.04; fewer episodes of culture confirmed sepsis, mean difference −0.7 (−1.3, −0.2) episodes, p = 0.04; less parenteral nutrition, mean difference −11.5 (CI −20, −3) days, p = 0.03; tolerated full milk feeds (165 ml/kg/day) earlier, mean difference −11.2 (CI −19, −3) days, p = 0.03; reduced requirement for supplemental oxygen, mean difference −22.4 (CI−41.5, −3.3) days, p = 0.02; and were discharged home earlier, mean difference −22.1 (CI −42.1, −2.2) days, p = 0.04. There was no significant difference in the relative risk of any complication.
CONCLUSIONS Trophic feeding improves clinical outcome in ill preterm infants requiring parenteral nutrition.
Key messages
Key messages
Timing of the introduction of milk feeds in sick low birthweight infants is controversial. Almost all infants with non-surgical illness can tolerate at least some milk as trophic feeds.
Trophic feeding leads to improved energy intake, weight gain, milk tolerance, less sepsis and earlier hospital discharge. No increase in major complication rate is seen following trophic feeding.
- trophic feeding
- enteral nutrition
- parenteral nutrition
- infant
- low birthweight