From the Journals

Faster enteral feeding does not up adverse outcomes risk in preterm infants


 

FROM NEW ENGLAND JOURNAL OF MEDICINE

Feeding preterm or low-birth-weight infants a faster increment of daily milk does not appear to increase their risk of developing adverse outcomes, including moderate or severe neurodevelopmental disability and necrotizing enterocolitis, according to recent research published in the New England Journal of Medicine.

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Although some data have shown rapidly increasing the speed of enteral-feeding volumes for preterm infants can raise the risk of necrotizing enterocolitis, these data are from observational case-control and uncontrolled studies, said Jon Dorling, MD, of the division of neonatal–perinatal medicine at Dalhousie University in Halifax, N.S., and colleagues in their study.

Dr. Doring and colleagues randomized 2,804 infants who were either very preterm or with a very low birth weight to receive daily milk increments at different volumes until the infants reached full feeding volume. Infants in the faster-increment group received daily milk at 30 mL per kg of body weight, while the slower-increment group received 18 mL per kg of body weight each day. The researchers analyzed infant survival without moderate or severe neurodevelopmental disability, with secondary outcomes of sepsis, necrotizing enterocolitis, and cerebral palsy at 24 months.

Overall, the researchers had information on the primary outcome for 87.4% of infants in the faster-increment group and 88.7% of infants in the slower-increment group. They found that 65.5% of infants in the faster-increment group and 68.1% of infants in the slower-increment group achieved an outcome of survival without moderate or severe neurodevelopmental disability at 24 months (adjusted risk ratio, 0.96; 95% confidence interval, 0.92-1.01; P equals .16). Secondary outcomes showed similar rates of adverse outcomes in the two groups, with 29.8% of infants in the faster-increment group and 31.1% of infants in the slower-increment group developing late-onset sepsis (aRR, 0.96; 95% CI, 0.86-1.07). Infants in the faster-increment group also had a similar rate of necrotizing enterocolitis (5.0%), compared with infants in the slower-increment group (5.6%) (aRR, 0.88; 95% CI, 0.68-1.16). Motor impairment was higher among infants in the faster-increment group (7.5%), compared with the slow-increment group (5.0%).

In the faster-increment group, the median number of days to reach full milk-feeding volumes was 7 vs. 10 in the slower-increment group.

“Although these feeding outcomes seem to favor faster increments, the risk of moderate or severe motor impairment was unexpectedly higher in the faster-increment group than in the slower-increment group,” the researchers said. “This observation is unexplained, and there were not more cases of late-onset sepsis or necrotizing enterocolitis in the faster-increment group.”

It is possible that it is a chance finding, since it was one of multiple secondary outcomes assessed, but biologically plausible explanations include increased cardiorespiratory events from pressure on the diaphragm or inability to absorb enteral nutrition,” they added.

The researchers said one potential limitation of the study was that it was unblinded.

This study was funded by the Health Technology Assessment Programme of the National Institute for Health Research. The authors reported various relationships with Baxter Bioscience, Chiesi Farmaceutici, Danone Early Life Nutrition, Fresenius Kabi USA LLC, National Institute for Health Research, Nestle Nutrition Institute, Nutrina, Medical Research Council, and Prolacta Biosciences in the form of consultancies, grants, travel reimbursement, board memberships, and editorial board appointments.

SOURCE: Doring J et al. N Eng J Med. 2019. doi: 10.1056/NEJMoa1816654.

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