Early trophic feeding for very low birth weight infants

Bombell S, McGuire W

Published Online:

July 8, 2009

There is insufficient evidence to determine whether feeding very low birth weight infants small quantities of milk during the first week after birth (early trophic feeding) helps bowel development and improves subsequent feeding, growth and development. Analysis of eight trials does not suggest that this practice increases the risk of a severe bowel disorder called "necrotising enterocolitis". Further trials are needed to provide robust evidence to inform this key area of care.

Abstract (click to read)

Background:

The introduction of enteral feeds for very low birth weight (VLBW) infants is often delayed due to concern that early introduction may not be tolerated and may increase the risk of necrotising enterocolitis. However, enteral fasting may diminish the functional adaptation of the immature gastrointestinal tract and prolong the need for parenteral nutrition with its attendant infectious and metabolic risks. Early trophic feeding, giving infants very small volumes of milk during the first week after birth, may promote intestinal maturation, enhance feeding tolerance and decrease time to reach full enteral feeding independently of parenteral nutrition.

Objectives:

To determine the effect of early trophic feeding versus enteral fasting on feed tolerance, growth, and the incidence of necrotising enterocolitis, mortality and other morbidities in VLBW infants.

Search strategy:

The standard search strategy of the Cochrane Neonatal Group was used. Searches were made of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2009), MEDLINE (1966 - February 2009), EMBASE (1980 - February 2009), CINAHL (1982 - February 2009), conference proceedings, and previous reviews.

Selection criteria:

Randomised or quasi-randomised controlled trials that assessed the effects of early trophic feeding (milk volumes up to 24 ml/kg/day introduced before 96 hours postnatal age and continued until at least one week after birth) versus a comparable period of enteral fasting in VLBW infants.

Data collection and analysis:

The standard methods of the Cochrane Neonatal Group were used, with separate evaluation of trial quality and data extraction by two review authors. Data were synthesised using a fixed effects model and reported using typical relative risk, typical risk difference and weighted mean difference.

Main results:

Nine trials, in which a total of 754 VLBW infants participated, were eligible for inclusion. These trials did not provide any evidence that early trophic feeding affected feed tolerance or growth rates in VLBW infants. Meta-analysis did not detect a statistically significant effect on the incidence of necrotising enterocolitis: typical relative risk 1.07 (95% confidence interval 0.67, 1.70); typical risk difference 0.01 (95% confidence interval -0.04, 0.05).

Authors' conclusions:

The available data cannot exclude important beneficial or harmful effects and are insufficient to inform clinical practice. Further large pragmatic randomised controlled trials are needed to determine how early trophic feeding compared with enteral fasting affects important clinical outcomes in VLBW infants.

This record should be cited as:

Bombell S, McGuire W. Early trophic feeding for very low birth weight infants. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD000504. DOI: 10.1002/14651858.CD000504.pub3

Assessed as up to date:

March 9, 2009

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Neonatal Group

Health topics:

Neonatal care > Parenteral feeding

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Early trophic feeding for very low birth weight infants

More like this

Copyright © 2012 - The Cochrane Collaboration