Page 17 - Delaware Medical Journal - June 2017
P. 17
SCIENTIFIC ARTICLE
protocol improved growth velocity in VLBW infants. In our population of VLBW infants, growth velocity improved by 2 grams/d after implementation of
the protocol. There were no differences in other measured outcomes including incidence of culture positive sepsis
or line days. Our study suggests that decreasing variation in feeding practices by implementing a standardized feeding protocol may be used to improve growth velocity in VLBW infants.
There are large variations between clinicians and institutions in how of VLBW infants are fed. Many studies were designed to determine the best feeding strategy for this high-risk population, but questions remain about the best approach. One strategy includes implementing early trophic feeds, with small feeding volumes given in shown to promote intestinal maturation, improve feeding tolerance, and decrease
the time to full enteral feeds.7 A Cochrane review published in 2009 reviewed nine trials to assess if there is an association with early trophic feeds, feeding tolerance, and growth rates. A positive effect of providing early trophic feeds was not found in VLBW infants, but the study suggested that further studies need to be done to further clarify effects of trophic feeds.8 Another study done on premature infants (25 0/7 – 30 6/7 weeks gestation) who were given early trophic feeds of 1ml/kg/hr showed that this group
of infants reached 120ml/kg/d of enteral nutrition sooner than the control group, who
life. It was also found that there was better growth by day of life 30 in the early-feeding group versus the NPO group.9
Berseth et al. looked at the incidence of NEC in infants given trophic feeds for an early advancing feeding schedule of
20ml/kg/d. The infants in the advancing group showed a 10 percent NEC rate versus 1.4 percent in the trophic feeds group.7 Similarly, McClure et al. showed that infants given trophic feeds while still requiring ventilatory support, had greater weight gain and head circumference, fewer
episodes of sepsis, fewer days of parenteral nutrition, and better feeding tolerance compared to infants who received only parenteral nutrition while on mechanical ventilation.10 Our data showed no effect
of protocolizing feeds on the outcomes of NEC or sepsis.
TABLE 2: Analyses of Pre- and Post-Intervention Variables for All Infants
Variable
Pre Post
Mean ± SD or %
p-values
Central Line days
Pre (N=49)
8.9 ± 14.1
0.301
Post (N=59)
14.8 ± 17.7
Days to 120ml/kg/d
Pre (N=49)
10.4 ± 5.6
0.128
Post (N=59)
13.7 ± 8.2
Days to 150ml/kg/d
Pre (N=49)
12.3 ±7.3
0.177
Post (N=59)
17.1 ± 12.2
Initial days TPN
Pre (N=49)
9.8 ± 7.3
0.160
Post (N=59)
14.0 ± 8.0
Total days of TPN
Pre (N=49)
12.1 ± 12.6
0.267
Post (N=59)
16.9 ± 12.6
Mean growth velocity (grams/day)
Pre (N=49)
18.4 ±6.3
0.037
Post (N=59)
20.7 ± 5.5
Culture positive sepsis (%)
Pre (N=56)
4.2
0.623
Post (N=70)
10.2
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