Original Article
Continuous Feeding Promotes Gastrointestinal Tolerance and Growth in Very Low Birth Weight Infants

https://doi.org/10.1016/j.jpeds.2005.03.003Get rights and content

Objective

To compare the effects of continuous versus intermittent feeding on gastrointestinal tolerance and growth in very low birth weight (VLBW) infants.

Study design

In a randomized, controlled trial conducted at 3 neonatal units, 70 premature infants with a gestational age 24 to 29 weeks and birth weight < 1200 g were assigned to 1 of 3 feeding methods: continuous nasogastric feeding, intermittent nasogastric feeding, or intermittent orogastric feeding. Feeding was initiated within 30 hours of birth. Daily enteral and parenteral volumes, caloric and protein intakes, growth, enteral intolerance, and clinical complications were recorded. Cox regression analysis was used to determine primary outcome, the time to achieve full enteral feeding.

Results

The continuously fed infants achieved full enteral feeding significantly faster than the intermittently fed infants (hazard ratio [HR] = 1.86; 95% confidence interval [CI] = 1.07 to 3.22). In stratified analysis according to birth weight, the improvement was even more pronounced in the smallest infants, those with birth weight ≤850 g (adjusted HR = 4.13; 95% CI = 1.48 to 11.53). Growth rate was significantly faster in the continuously fed infants (P = .002).

Conclusion

In VLBW infants, continuous feeding seems to be better than intermittent feeding with regard to gastrointestinal tolerance and growth.

Section snippets

Study Design and Population

Infants were enrolled within 30 hours of birth and randomly assigned to 1 of the following tube feeding methods: continuous nasogastric feeding (CNG) (index group), intermittent nasogastric feeding every 3 hours (ING) (control group 1), and intermittent orogastric feeding every 3 hours (IOG) (control group 2). Two control groups were chosen to detect any differences of the placement of the feeding tube (oral or nasal) on gastrointestinal tolerance as well as on the infant's behavior. The impact

Results

Of all eligible VLBW infants born between February 1998 and November 2001, 70 infants (91%) were randomly assigned to 1 of 3 feeding groups. Seven eligible infants (9%) did not participate in the study; 5 were excluded due to a lack of parental consent to partake in the study, 1 was missed, and 1 was excluded because the mother died during caesarean section delivery. Two infants were excluded after randomization because of diagnosed malformations.

There were no statistically significant

Discussion

This study demonstrates that continuous feeding of infants with birth weight < 1200 g and GA of 24 to 29 weeks improved gastrointestinal tolerance and shortened the time needed to achieve full enteral feeding relative to bolus feeding. The study also indicates that continuous feeding might be even more physiologically suitable with regard to enteral tolerance in the extremely low birth weight infants ≤850 g, though the relatively low number of subjects hampers a definitive conclusion.

The

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    Supported by grants from the Vårdal Foundation, the Mjölkdroppen Foundation, and the Frimurare Barnhuset Foundation, Stockholm, Sweden.

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