Effect of Feeding Schedule on Time to Reach Full Feeds in neonates weighing 500 to 1500 grams: A Randomized Trial
Tali SH
Published on: 2023-12-15
Abstract
Aim: To compare the effect of 3-hourly (3-h) versus 2-hourly (2-h) feeding schedules on time to reach full feeds in neonates weighing less than 1500 grams
Materials and Methods: This was a randomized trial conducted in a level 3 neonatal intensive care unit, Surya Children’s Hospital Mumbai, India. We enrolled 120 preterm neonates with birth weights of 501 to 1500 g. The neonates were divided into 2 strata based on birth weight: 501 to 1000 g and 1001 to 1500 g. The neonates were randomized into 2 orogastric feeding schedules: 8 or 12 feeds (3-h or 2-h schedules, depending upon randomization), and a uniform feeding protocol was followed. Analysis was performed using the intention-to-treat principle. Categorical variables were compared using the Chi-square test. Continuous measures between groups were compared using 2-sample t test or Mann Whitney U test as appropriate. Data were analyzed using IBM SPSS version 21 software. P <0.05 was considered significant.
Primary outcome measures were time (in days) to reach full feeds (defined as tolerance of 150 mL/kg/d of feeds for at least 48 h). Secondary outcome measures were time (in days) to attain birth weight; time (in days) to discharge; weight, length, and head circumference at discharge; incidence of feed intolerance, necrotizing enterocolitis (NEC), Intravascular hemorrhage (IVH), screen-positive sepsis, culture-positive sepsis, hypoglycemia, apnea, jaundice and retinopathy of prematurity (ROP), duration of total parental nutrition (TPN) and nursing; and mortality.
Results: A total of 215 neonates were assessed for eligibility, of which 95 were excluded. Hence, 120 neonates were enrolled in the trial. There was no significant difference in time (in days) to reach full feeds in the 2-h versus 3-h groups (9.53 ± 4.26 vs 9.85 ± 5.48; P = 0.73). There was no significant difference between the 2 groups in any of the secondary outcomes. The total time spent per day in feeding was significantly lesser in the 3-h feeding schedule groups (P= 0.04). Subgroup analysis revealed that among the neonates in the lower birth weight strata(501 to 1000 gms), those fed 2 hourly reached full feeds earlier compared with those fed 3-hourly (2-h group: 11.24 ± 2.88 d vs 3-h group: 14.14 ± 4.98 d; P = .041).
Conclusions: There was no significant difference in time to reach full feeds in all the neonates, irrespective of whether they were fed 2-h or 3-h. However, neonates < 1000 g reached full feeds earlier when fed more frequently (2-h feeding schedule).
Keywords
Feeding schedules; Neonates weighing; Parental nutrition; MortalityBiography
Dr. Showkat Hussain Tali, grew up in J and K, India. After obtaining Bachelor’s degree in 2005, he obtained MD in Pediatric Medicine from University of Kashmir in 2010. In 2013 he joined Department of neonatology Surya Children’s Hospital Mumbai and became Board Certified in neonatology from the National Board of India in 2015. In November 2016 he joined Adesh University Punjab as Assistant Professor Pediatrics and in charge Neonatology. At present he is working as assistant professor pediatrics Govt. Medical College Anantnag, J and K India. He has more than 2 dozen publications in national and international journals. He has received science talent search award from the Govt. of Jammu and Kashmir in 1997 and was awarded by Help Foundation and Raju Gandhi foundation, India, for creative writing in 2006. In 2017 he was awarded official spot light certificate at New Delhi for his overall achievements. In 2022 his first poetry collection gets best book award. In 2017 he presented his research work in 3 international conferences across the globe (Czech Republic, Prague; Los Angeles, USA; Dubai, UAE). Apart from giving an oral speech and presenting a poster, he CO-Chaired a scientific session and was the moderator of 14th world pediatric and neonatal Care Conference Los Angeles, California, USA. His oral presentation was judged as the best at the 7th international Arab Neonatal Care conference and got the first place award. He attended international conference “Advances in Neonatal and Pediatric Nutrition”, at London, UK (July 19 to 21, 2018) as key note speaker and presented two papers related to infant and neonatal nutrition. He also Co-chaired a session with Professor Alexander Oleskein, Moscow state university Russia at the same conference. In 2019 he presented his research work at Osaka Japan during 2nd international conference on nutraceuticals and 5th international conference on food beverages. He is editorial board member of archives of pediatrics and neonatology, an international journal published from USA. In 2021 he was awarded ENS (Early nutrition specialist) certificate by Ludwig Maximilian University of Munich, Germany. He is one of the authors of text book of clinical neonatology published by Indian academy of pediatrics.