Does Starting Feeds on the First Day of Life Help Premature Infants Reach Full Volume Feeds Sooner?
University of Tennessee
Summary
Feeding advancements in ELBW infants have evolved over decades. The fear of causing mortality and morbidity, notably NEC, have made providers cautious when advancing feeds. ELBW infants initially remained NPO for several days before initiating trophic feeds. However, data then showed that there was no increase in mortality and morbidity if trophic feeds were initiated earlier. Then data showed that a short duration of trophic feeds did not increase mortality and morbidity when compared to a prolonged duration. More recent data showed that enteral feeding should be initiated early, preferably within 24 hours of birth, because it may promote feeding tolerance, shorten the time to reach total enteral feeding, and reduce the incidence of extrauterine growth restriction and late onset sepsis without increasing the risk of developing NEC. The management of enteral nutrition in ELBW infants is still very variable. For example, there is no consensus on the optimal time point after birth at which enteral nutrition can be started. This study evaluates the benefits of starting feeds by 6 hours of life Purpose: The primary aim of this study is to evaluate if in infants ≤ 1000g birth weight, is there a benefit initiating feeds by 6 hours of life (compared to current feeding practice data of 3 days of life) on decreasing the time to attain full feeds in the first 30 days of life. The secondary aim is to evaluate if antenatal feeding discussions would streamline feeding management post-delivery.
Description
Rationale: Although current evidence supports initiating enteral feedings as early as the first day of life in extremely low birth weight infants, there are two main barriers that are usually associated with the initiation of feeding not taking place until an average of the third day of life. Since it is common to supplement the infant's nutrition with donor breast milk, and since donor breast milk requires parental consent, the process of consenting is usually done after the infant is born. This would be the time when the parents are updated with the status of their child and the time when ot…
Eligibility
- Age range
- 1–6 years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: 1. All infants less than or equal to 1000 g 2. Clinical care team in agreement with patient's participation 3. All mothers with pregnancies with EFW close to 1000g or less. Exclusion Criteria: 1 congenital malformations that may affect gastro intestinal perfusion 2 Clinically progressing towards imminent death 3 congenital gastrointestinal obstructions 4 Mothers unlikely to deliver infants ≤ 1000g 5 Infant on pressors other than dopamine given at \< 5mcg/kg/min. Dopamine is an exclusion if administered at a dose exceeding 5mcg/kg/min. 6 Mothers who are not in a soun…
Interventions
- OtherStarting feeds within 6 hours of life
Starting feeds within 6 hours of life
- OtherStandard feeding protocol
Starting feeds based on standard protocol as per primary team
Location
- Regional One HealthMemphis, Tennessee