444 - Early Total Enteral Feeding (ETEF) versus Conventional Enteral Feeding (CEF) in Preterm Neonates between 27-32 weeks of Gestation: Randomized Control Trial

Poster Number: 444
Publication Number: 444.2151

Background: India accounts for the highest number of preterm births and nutrition is a critical component of their overall management. Uncertainty exists regarding feeding policy and initiating early total enteral feeds (ETEF) in sick preterm neonates.

Objective: To compare the time of attainment of full enteral feeds in sick neonates between 27-32 weeks of gestation randomized to receive early total enteral feeding (ETEF) versus conventional enteral feeding (CEF).

Design/Methods: In this randomized control trial, 183 infants were allocated to either ETEF (n=90) or CEF (n=93) group. In the ETEF group, feeds were initiated as full enteral feeds at 80 mL/Kg whereas in the CEF group, as trophic feeds at 20 ml/kg on day one of life. The rest of the day’s requirements in the CEF group was provided as intravenous fluids.

Results: The baseline variables were comparable in the two groups. Mean birth weight (grams) and gestation (weeks) of the 183 enrolled neonates was 1357 ± 247 and 1254±253, and 30.6 ± 1.4 & 29.9 ± 1.5 in ETEF and CEF groups respectively. Neonates in the ETEF group reached full enteral feeds significantly earlier than the CEF group (6.8 ± 1.8 vs. 9.1 ± 4.3 days postnatal age; mean difference –2.3[–3.2 to –1.3]; p < 0.001). There was a significant reduction in the episodes of feed intolerance (37.6% vs. 18.9%) and sepsis (48% vs 34%) in ETEF group. Mean duration of hospital stay (days) in ETEF group was 12 days shorter (25.9 ±13.7 vs. 38.1 ± 4.7) (p=0.001).
Reduction was also noted in anaemia of prematurity, bronchopulmonary dysplasia (BPD), and significantly higher weight gain was observed at 1 month of age in the ETEF as compared to the CEF group. None of the neonates in the ETEF group developed NEC. Mortality was higher in CEF arm (10.8% vs 4.4%; RR 2.62 (0.86 to 8.03).

Conclusion(s): Early total enteral feeding in sick preterm neonates with gestation 27-32 weeks leads to early attainment of full feeds, earlier regaining of birth weight, shorter hospital stay, and reduced incidence of BPD as well as ROP, without increase in incidence of feed intolerance, NEC, sepsis, or mortality.