Abstract 1650

Background: Feeding intolerance (FI) frequently occurs in very low birth weight (VLBW) infants; it may prolong the time to reach full enteral feeding, and the time on parenteral nutrition. There is no consensus on whether the mode of feeding (intermittent bolus feeds (IBF) vs continuous drip feeding (CDF)) may influence FI. Previous clinical trials on relatively large preterm infants have been inconclusive.

Hypothesis: We conducted a two-center, prospective, randomized trial to test the hypothesis that CDF is better tolerated than IBF in small VLBW infants.

Design: We recruited 28 VLBW infants born with a birthweight (BW)<1250 g. A feeding protocol establishing the time to start feeds, reach full feeds & the rate of daily volume increments was created, taking into account various risk-factors for Necrotizing Enterocolitis (NEC) e.g. birthweight, Apgar scores, blood pressure instability etc... We aimed to start feeds early, with slow daily increments. Patients were randomized to either IBF (every 3 hours if BW>750g, & every 2 hours if <749g) or CDF. IBF was by gravity, & CDF was by syringe pump. Gastric content was checked every 4 hours. FI was defined as a gastric residual of more than 20% of the volume given in the preceding 4 hours. The presence of gastric residuals >20% prompted the activation of a specific protocol whereby feeds were continued, or stopped for a given period. This protocol was applied by physicians not participating in the research. The following data were recorded and/or calculated: Time to reach full feeds (150cc/Kg/d)(by design, and real), daily weight, caloric intake, residual gastric volume, and the type of feeding (formula vs human milk vs both). The major outcome variable considered, defined as "delay", was the difference between the theoretical time (per protocol) and the real time it took to reach full feeds. Results are means±SD and a p-value of <0.05 is considered significant.

Results: 5 infants were excluded from analysis because of death (n=4), or protocol deviation (n=1). The remaining 23 infants had been randomized to IBF (n=13) or CDF (n=10). (Table) In backward stepwise multiple regression analysis taking into account birthweight, mode of feeding, type of feeding & ventilatory status at entry in the study, only mode of feeding (IBF vs CDF) affected FI.

Table 1 No caption available
Full size table

Conclusion: Contrary to our hypothesis, gravity IBF appears to be more effective than CDF in improving FI in small VLBW infants.