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Am J Perinatol 2024; 41(S 01): e394-e399
DOI: 10.1055/s-0042-1755551
Original Article

Continuous versus Bolus Gastric Tube Feeding in Very Low Birth Weight Infants Supported with Noninvasive Respiratory Support: A Randomized, Pilot Study

Liron Borenstein-Levin 
1   Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
2   Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
2   Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
,
Arieh Riskin
2   Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
3   Neonatal Intensive Care Unit, Bnai Zion Medical Center, Haifa, Israel
,
Ori Hochwald
1   Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
2   Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
,
Fanny Timstut
1   Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
,
Sofia Sendler
1   Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
,
Irit Shoris
3   Neonatal Intensive Care Unit, Bnai Zion Medical Center, Haifa, Israel
,
Yoav Littner
1   Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
2   Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
,
Gil Dinur
1   Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
2   Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
,
Amir Kugelman
1   Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
2   Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
› Author Affiliations Funding This study was supported by a grant from Materna Research Institute.
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Abstract

Objectives This study aimed to compare time to full feeding (TFF) between continuous gastric feeding (CGF) and bolus feeding (BF) in very low birth weight (VLBW) infants supported with noninvasive ventilation (NIV) and to evaluate feasibility and identify methodological pitfalls for future large-scale studies.

Study Design This study is a randomized controlled, prospective, pilot study. VLBW premature infants, supported with NIV, were randomized while still on trophic feeding <20 mL/kg/day to receive feeding over 2 hours of CGF or over 15- to 30-minute BF. The primary outcome was TFF. Analysis was done by intention to treat.

Results Overall, 32 infants were included in this analysis, 17 in the CGF group and 15 in the BF group. Infants in the CGF group were significantly younger than the BF group (mean ± standard deviation [SD] gestational age [GA] 26.9 ± 1.2 vs. 28.9 ± 1.5 weeks, respectively). TFF was comparable with median (interquartile range [IQR]) for the two groups, 10.0 (10.0, 19.0) days in the BF group versus 12.0 (9.0, 13.0) days in the CGF group (p = 0.59). Feeding length was not found to significantly affect TFF in multivariate analysis correcting for GA. Groups were comparable in weight gain, gastrointestinal complications, length of NIV, bronchopulmonary dysplasia incidence, and age at discharge. Most infants from both groups (60% of BF and 70% of CGF) required changes in feeding length.

Conclusion In this pilot study, among VLBW infants supported with NIV, TFF was comparable between the BF and CGF groups. These results should be interpreted with caution due to the small sample size and despite the multivariate analysis correcting for the different GA. Interestingly, most infants required changes in feeding length regardless of their allocation. This feasibility study emphasizes the need for careful attention to randomization and strict feeding protocols including criteria for switching allocation in future large-scale studies aimed at determining the preferred feeding length during NIV in VLBW infants.

Key Points

  • Among infants supported with NIV, length of feeding affects gastric venting.

  • BF might increase gastrointestinal reflux, while continuous feeding hinders gastric decompression.

  • Among infants supported by NIV, feeding tolerance was comparable between bolus and continuous groups.

Keywords

feeding intolerance - noninvasive respiratory support - premature infant - tube feeding

* Liron Borenstein-Levin, MD, and Arieh Riskin, MD, PhD, equally contributed to the study and are both co–first authors.




Publication History

Received: 26 April 2022

Accepted: 20 June 2022

Article published online:
12 September 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Macdonald PD, Skeoch CH, Carse H. et al. Randomised trial of continuous nasogastric, bolus nasogastric, and transpyloric feeding in infants of birth weight under 1400  g. Arch Dis Child 1992; 67 (4 spec no): 429-431
    CrossrefPubMedGoogle Scholar
  • 2 Schanler RJ, Shulman RJ, Lau C, Smith EOB, Heitkemper MM. Feeding strategies for premature infants: randomized trial of gastrointestinal priming and tube-feeding method. Pediatrics 1999; 103 (02) 434-439
    CrossrefPubMedGoogle Scholar
  • 3 Dollberg S, Kuint J, Mazkereth R, Mimouni FB. Feeding tolerance in preterm infants: randomized trial of bolus and continuous feeding. J Am Coll Nutr 2000; 19 (06) 797-800
    CrossrefPubMedGoogle Scholar
  • 4 Akintorin SM, Kamat M, Pildes RS. et al. A prospective randomized trial of feeding methods in very low birth weight infants. Pediatrics 1997; 100 (04) E4
    CrossrefPubMedGoogle Scholar
  • 5 Rövekamp-Abels LWW, Hogewind-Schoonenboom JE, de Wijs-Meijler DPM. et al. Intermittent bolus or semicontinuous feeding for preterm infants?. J Pediatr Gastroenterol Nutr 2015; 61 (06) 659-664
    CrossrefPubMedGoogle Scholar
  • 6 Wang Y, Zhu W, Luo BR. Continuous feeding versus intermittent bolus feeding for premature infants with low birth weight: a meta-analysis of randomized controlled trials. Eur J Clin Nutr 2020; 74 (05) 775-783
    CrossrefPubMedGoogle Scholar
  • 7 Poets CF, Lorenz L. Prevention of bronchopulmonary dysplasia in extremely low gestational age neonates: current evidence. Arch Dis Child Fetal Neonatal Ed 2018; 103 (03) F285-F291
    CrossrefPubMedGoogle Scholar
  • 8 LeVan JM, Brion LP, Wrage LA. et al; Eunice Kennedy Shriver NICHD Neonatal Research Network. Change in practice after the surfactant, positive pressure and oxygenation randomised trial. Arch Dis Child Fetal Neonatal Ed 2014; 99 (05) F386-F390
    CrossrefPubMedGoogle Scholar
  • 9 Kugelman A, Borenstein-Levin L, Jubran H. et al. Less is more: modern neonatology. Rambam Maimonides Med J 2018; 9 (03) e0023
    CrossrefPubMedGoogle Scholar
  • 10 Friedlich P, Lecart C, Posen R, Ramicone E, Chan L, Ramanathan R. A randomized trial of nasopharyngeal-synchronized intermittent mandatory ventilation versus nasopharyngeal continuous positive airway pressure in very low birth weight infants after extubation. J Perinatol 1999; 19 (6, pt. 1): 413-418
    CrossrefPubMedGoogle Scholar
  • 11 Barrington KJ, Bull D, Finer NN. Randomized trial of nasal synchronized intermittent mandatory ventilation compared with continuous positive airway pressure after extubation of very low birth weight infants. Pediatrics 2001; 107 (04) 638-641
    CrossrefPubMedGoogle Scholar
  • 12 Kugelman A, Feferkorn I, Riskin A, Chistyakov I, Kaufman B, Bader D. Nasal intermittent mandatory ventilation versus nasal continuous positive airway pressure for respiratory distress syndrome: a randomized, controlled, prospective study. J Pediatr 2007; 150 (05) 521-526 , 526.e1
    CrossrefPubMedGoogle Scholar
  • 13 Yoder BA, Stoddard RA, Li M, King J, Dirnberger DR, Abbasi S. Heated, humidified high-flow nasal cannula versus nasal CPAP for respiratory support in neonates. Pediatrics 2013; 131 (05) e1482-e1490
    CrossrefPubMedGoogle Scholar
  • 14 Behnke J, Estreich V, Oehmke F, Zimmer K-P, Windhorst A, Ehrhardt H. Compatibility of rapid enteral feeding advances and noninvasive ventilation in preterm infants-an observational study. Pediatr Pulmonol 2022; 57 (05) 1117-1126
    CrossrefPubMedGoogle Scholar
  • 15 Bozzetti V, De Angelis C, Tagliabue PE. Nutritional approach to preterm infants on noninvasive ventilation: an update. Nutrition 2017; 37: 14-17
    CrossrefPubMedGoogle Scholar
  • 16 Jaile JC, Levin T, Wung JT, Abramson SJ, Ruzal-Shapiro C, Berdon WE. Benign gaseous distension of the bowel in premature infants treated with nasal continuous airway pressure: a study of contributing factors. AJR Am J Roentgenol 1992; 158 (01) 125-127
    CrossrefPubMedGoogle Scholar
  • 17 Morgan J, Bombell S, McGuire W. Early trophic feeding versus enteral fasting for very preterm or very low birth weight infants. Cochrane Database Syst Rev 2013; ;( (03) CD000504
    PubMedGoogle Scholar
  • 18 Stoll BJ, Hansen NI, Bell EF. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA 2015; 314 (10) 1039-1051
    CrossrefPubMedGoogle Scholar
  • 19 Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986; 33 (01) 179-201
    CrossrefPubMedGoogle Scholar
  • 20 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (04) 529-534
    CrossrefPubMedGoogle Scholar
  • 21 Riskin A, Cohen K, Kugelman A, Toropine A, Said W, Bader D. The impact of routine evaluation of gastric residual volumes on the time to achieve full enteral feeding in preterm infants. J Pediatr 2017; 189: 128-134
    CrossrefPubMedGoogle Scholar
  • 22 Maas C, Franz AR, von Krogh S, Arand J, Poets CF. Growth and morbidity of extremely preterm infants after early full enteral nutrition. Arch Dis Child Fetal Neonatal Ed 2018; 103 (01) F79-F81
    CrossrefPubMedGoogle Scholar
  • 23 Torrazza RM, Parker LA, Li Y, Talaga E, Shuster J, Neu J. The value of routine evaluation of gastric residuals in very low birth weight infants. J Perinatol 2015; 35 (01) 57-60
    CrossrefPubMedGoogle Scholar
  • 24 Weeks CL, Marino LV, Johnson MJ. A systematic review of the definitions and prevalence of feeding intolerance in preterm infants. Clin Nutr 2021; 40 (11) 5576-5586
    CrossrefPubMedGoogle Scholar
  • 25 Oddie SJ, Young L, McGuire W. Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants. Cochrane Database Syst Rev 2021; 8 (08) CD001241
    CrossrefPubMedGoogle Scholar
  • 26 Thoene M, Anderson-Berry A. Early enteral feeding in preterm infants: a narrative review of the nutritional, metabolic, and developmental benefits. Nutrients 2021; 13 (07) 2289
    CrossrefPubMedGoogle Scholar
  • 27 Rojahn A, Lindgren CG. Enteral feeding in infants <1250  g starting within 24 h post-partum. Eur J Pediatr 2001; 160 (10) 629-632
    CrossrefPubMedGoogle Scholar
  • 28 Sadrudin Premji S, Chessell L, Stewart F. Continuous nasogastric milk feeding versus intermittent bolus milk feeding for preterm infants less than 1500 grams. Cochrane Database Syst Rev 2021; 6 (06) CD001819
    PubMedGoogle Scholar
  • 29 Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet J-M, Carlin JB. COIN Trial Investigators. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med 2008; 358 (07) 700-708
    CrossrefPubMedGoogle Scholar
  • 30 Finer NN, Carlo WA, Walsh MC. et al; SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med 2010; 362 (21) 1970-1979
    CrossrefPubMedGoogle Scholar
  • 31 Kiciman NM, Andréasson B, Bernstein G. et al. Thoracoabdominal motion in newborns during ventilation delivered by endotracheal tube or nasal prongs. Pediatr Pulmonol 1998; 25 (03) 175-181
    CrossrefPubMedGoogle Scholar