Effect of early versus late trophic feeding initiation on high dependency unit stay in preterm infants: a non-randomised clinical trial

Abstract

Objective: To evaluate the impact of early (<48 hrs) versus late (>72 hrs) initiation of trophic feeding in preterm infants on time to reach full enteral feeds and length of stay in the high dependency unit, and on the incidence of complications.

Method: The clinical trial was conducted at the Neonatal High Dependency Unit, Lady Reading Hospital, Peshawar, Pakistan, from July 30 to October 30, 2023, and comprised preterm infants with gestation age 28-36 weeks and birth weight 1-2.5kg. The subjects were divided into two groups. In group A, feeding was initiated at <48 hours of birth, while in group B, feeding was initiated after 72 hours of birth. Feeding was given at 12ml/kg/day and advanced with incremental increase in both the groups. The neonates were assessed for success of trophic feeding and development of complications. Stay in the high dependency unit was also documented. Data was analysed using SPSS 23.

Results: Of the 240 preterm infants, 141(58.8%) were boys and 99(41.3%) were girls. There were 120(50%) neonates in group A with mean gestational age 31.65+2.04 weeks, and 120(50%) in group B with mean gestational age 3117+2.46 weeks. There was no significant difference between the groups with respect to gender, gestational age and birthweight (p>0.05). The mean stay in high dependency unit was 6.14±2.74 days in group A compared to 12.07±4.11 days in group B (p<0.001). There was no significant difference between the groups concerning complications (p>0.05).

Conclusion: Early initiation of trophic feeding in preterm neonates had a significant positive impact without any significant increase in the risk of complications.

Clinical Trial Number: ACTRN12623000752662

https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385240&isClinicalTrial=False#:~:text=Registration%20number-,ACTRN12623000752662,-Ethics%20application%20statusn

Key Words: Preterm, Low birthweight, Trophic feeding, Necrotising enterocolitis.