The Effect of Early Versus Late Start of Minimal Enteral Nutrition on Clinical Outcomes of Parenterally Fed Preterm/Very Low Birth Weight Infants
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- Category: Vol. 81, December 2013
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The Effect of Early Versus Late Start of Minimal Enteral Nutrition on Clinical Outcomes of Parenterally Fed Preterm/Very Low Birth Weight Infants, RABAB E.H. EL-SAYED
Abstract
Background: Although parenteral nutrition has been used widely in management of preterm/very low birth weight infants admitted to the Neonatal Intensive Care Units (NICUs), a smooth transition to enteral feedings is desirable, with concerns about nutrient intolerance and the risk of necrotizing enterocolitis (NEC). This study aims to compare the effects of early with late start of minimal enteral feedings (MEN) on specific and non-specific clinical indicators of NEC in parenter-ally fed preterm/very low birth weight infants, as well as their clinical outcomes; including time to reach full enteral feedings, weight gain, glucose metabolism, use of phototherapy, and length of hospital stay.
Methods: A quasi-experimental design was used. A rep-resentative sample of 65 preterm (PT) and very low birth weight (VLBW) infants who admitted to the NICU affiliated to El-Mansoura University Children's Hospital from May 1st to 31th of October 2008 was randomly divided into intervention and control groups. Parenteral nutrition (PN) is initiated routinely in the first 24 hours of life for both the study two groups. Then, from day 2 to day 7 PNP, PT infants in the intervention group received trophic feeds of 12-24ml/kg/day of expressed breast milk (EBM) or preterm formula in addition to the estimated amount of PN, while infants in the control group received only PN according to the NICU feeding protocol (110-120 Kcal/kg/day). The effects of early (on day 2 NP) and late start (after day 7 PNP) of MEN on the clinical outcomes were compared between the two groups.
Results: Neonates in the control group were significantly more likely to show specific and non-specific clinical indicators of NEC. The mean days to reach full enteral feedings were significantly fewer for the intervention group (p<0.001), which also significantly reduced the time of their hospital stays (p<0.001). Moreover, Only 40% of neonates in the intervention group developed hyperbilirubinemia compared with 60% in the control group, but this difference was not significant (p=0.121).
Conclusion: Early start of MEN for PT and VLB W infants shortens the time to reach full enteral feedings, improves daily weight gain, produces fewer episodes of feeding intolerance, has beneficial effects on glucose and bilirubin metab-olism, and shortens the time of hospital stay than late start, even though caloric intake was equivalent among both groups. The study recommended providing PT and VLBW infants with fixed amount of MEN from day 2 to day 7 PNP.