Researchers have found in a new study that three hourly feeding does not increase the risk of hypoglycemia, necrotizing enterocolitis or feed intolerance when compared to two hourly feeding in very low birthweight neonates. The study has been published in Indian Pediatrics Journal.
Feeding of very low birthweight (VLBW) infants (1000-1500 g) is relatively difficult because majority of them are born with inadequate feeding skills, have feed intolerance, and are at an increased risk of necrotizing enterocolitis (NEC). Early initiation of enteral feeding is preferred for preterm VLBW babies with mothers own milk for less NEC and better neurodevelopment outcomes and preventing gastric atrophy and improving gut motility and reaching full feeds early.
There is no consensus regarding the feeding interval in very low birth weight (VLBW) babies. If 2-hourly feeding schedule is feasible without increasing harm to the neonate, the nursing time consumed in the feeding of VLBW babies can be reduced.
Therefore, ANITA YADAV and colleagues from the Neonatal Division, Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India conducted the present study to assess whether 3-hourly feeding is non-inferior to 2-hourly feeding with respect to time to reach full feeds in VLBW neonates.
The authors carried out an open-label, randomized controlled trial including a total of 350 neonates weighing between 1000 to 1500 grams, in whom feed could be started within 96 hours of life randomized to either 2-hourly or 3-hourly feeding schedule.
The results showed that –
The primary outcome of time to achieve full enteral feed was comparable in the two feeding schedule groups (median 5 days IQR 4-6 days in both groups; P=0.665).
Among the secondary outcomes, there were no significant differences in incidence of hypoglycemia (RR 0.86; 95% CI: 0.29-2.5) feed intolerance (RR 1.08: 95%CI: 0.5-2.3), and necrotizing enterocolitis (RR 0.8; 95% CI: 0.22-2.3) in both the groups.
Therefore, the authors concluded that "three-hourly feeding in very low birthweight babies does not increase the time to achieve full enteral feeds or increase the incidence of feed intolerance, hypoglycemia and NEC."