Preterm Infant Clinical Trial
Official title:
Early Versus Delayed Enteral Feeding for Achieving Full Feeding in Preterm Growth-Restricted Infants: A Randomized Clinical Trial
The introduction of enteral feeds for preterm, growth restricted infants are often delayed
due to concern that early introduction may not be tolerated and may increase the risk of
necrotizing enterocolitis. However, prolonged enteral fasting may diminish the functional
adaptation of the immature gastrointestinal tract and extend the need for parenteral
nutrition with its attendant infectious and metabolic risks. Early introduction of small
volumes of milk in the form of Trophic feeding, promote intestinal maturation, may enhance
feeding tolerance and decrease the time taken to reach full enteral feeding independently of
parenteral nutrition.
A Randomized Trial will be carried out over a period of 12 months in Department of
Neonatology of BSMMU. Sample size will be 50(25 in each group). Infants with gestation below
35 weeks, birth weight below the 10th percentile for gestational age, will be randomly
allocated by web-based randomization to commence enteral feeds "early," whose feeding will be
started from 24 to 48 hours of age or "late," whose feeding will be started from 48 to 72
hours of age. Gradually feeding will be increased. Rate of advancement of feeding will be
same for both groups. Primary outcomes will be time to achieve full enteral feeding sustained
for 72 hours. Statistical analyses will be performed by using Fisher Exact test and by
Student's t test for categorical data and quantitative data respectively. Logistic regression
analyses will be performed to determine the role of independent variable.
Eligible infants who will fulfill the inclusion criteria will be divided into two strata "Early feeding group" and " Late feeding group" by computer based randomization after taking informed written consent from parents or responsible caregivers. Feeding will be started in early feeding group from 24 to 48 hours of age or in late feeding group, from 48 to 72 hours of age. Initially 4 hourly feeding will be started with 0.5ml and 1 ml expressed breast milk in babies with birth weight <1200 grams and >1200 grams respectively. On the following day 3 hourly, thereafter 2 hourly feeding will be provided in both groups. Gradually amount of feeding will be increased after reaching 2 hourly feeding at the rate of 10 ml/kg/day for initial 10 days then 20ml/kg/day in 2 aliquots till full feeding(150ml/kg/day).For babies with birth weight <1200 gram, rate of feeding advancement 10 ml/kg/day till full feeds. Any baby who will develop shock (due to sepsis, cardiogenic, hypovolemic etc.) will be excluded and will be replaced by new one in same category as per protocol analysis. Follow up examinations will be done. ;
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