Transpyloric versus gastric tube feeding for preterm infants

McGuire W, McEwan P

Published Online:

October 8, 2008

Preterm infants often have poor co-ordination of sucking and swallowing and this can delay the establishment of safe oral feeding. Enteral feeds may be delivered through a catheter passed via the nose or the mouth into the stomach or upper small bowel. The review of trials found that babies receiving transpyloric tube feeding had more adverse effects, without any evidence of any increased benefit over gastric tube feeding.

Abstract (click to read)

Background:

Enteral feeding tubes for preterm infants may be placed in the stomach (gastric tube feeding) or in the upper small bowel (transpyloric tube feeding). There are potential advantages and disadvantages to both routes.

Objectives:

To determine the effect of feeding via the transpyloric route versus feeding via the gastric route on feeding tolerance, growth and development and adverse consequences in preterm infants who require enteral tube feeding.

Search strategy:

The standard search strategy of the Cochrane Neonatal Review Group was used. This included electronic searches of MEDLINE and EMBASE (up to March 2007) and of The Cochrane Controlled Trials Register in The Cochrane Library (Issue 1, 2007), and searches of the references in previous reviews including cross references.

Selection criteria:

Randomised or quasi-randomised controlled trials comparing transpyloric with gastric tube feeding in preterm infants.

Data collection and analysis:

Data were extracted using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by each author and synthesis of data using relative risk (RR) and weighted mean difference (WMD).

Main results:

Data from nine trials were available. No evidence of an effect on short term growth rates was found: weight: WMD -0.7 g/week (95% confidence interval (CI) -25.2, 23.8); crown heel length: WMD -0.7 mm/week (95% CI -2.4, 1.0); head circumference: WMD 0.6 mm/week (95% CI -0.9, 2.1). Longer term growth was reported in one study. There were not any statistically significant differences between the groups in the mean body weight or occipitofrontal head circumference at three months or at six months corrected age. None of the included studies provided data on neurodevelopmental outcomes. Transpyloric feeding was associated with a greater incidence of gastro-intestinal disturbance (RR 1.45, 95% CI 1.05, 2.09). There was some evidence that feeding via the transpyloric route increased mortality (RR 2.46, 95% CI 1.36, 4.46). However, the outcomes of the study that contributed most to this finding were likely to have been affected by selective allocation of the less mature and sicker infants to transpyloric feeding. No statistically significant differences in the incidence of other adverse events, including necrotising enterocolitis, intestinal perforation, and aspiration pneumonia was found.

Authors' conclusions:

No evidence of any beneficial effect of transpyloric feeding in preterm infants was found. However, evidence of adverse effects was noted. Feeding via the transpyloric route cannot be recommended for preterm infants.

This record should be cited as:

McGuire W, McEwan P. Transpyloric versus gastric tube feeding for preterm infants. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD003487. DOI: 10.1002/14651858.CD003487.pub2

Assessed as up to date:

March 20, 2007

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Primary Review Group:

Neonatal Group

Health topics:

Neonatal care > Feeding the low birthweight infant > Techniques of feeding

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Independent high-quality evidence for health care decision making

Transpyloric versus gastric tube feeding for preterm infants

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