Ad libitum or demand/semi-demand feeding versus scheduled interval feeding for preterm infants

McCormick FM, Tosh K, McGuire W

Published Online:

February 17, 2010

We identified eight small trials that examined whether feeding preterm infants in response to their own hunger cues is better than feeding set volumes of milk at predefined intervals. In general these were methodologically flawed and did not report on all important clinical outcomes. Some evidence was found to suggest that feeding preterm infants in response to their own hunger cues results in earlier hospital discharge by about 2 to 4 days. Further randomised controlled trials are needed to confirm this finding.

Abstract (click to read)

Background:

Scheduled interval feeding of prescribed enteral volumes is current standard practice for preterm infants. However, feeding preterm infants in response to their hunger and satiation cues (ad libitum or demand/semi demand) rather than at scheduled intervals might help in the establishment of independent oral feeding, increase nutrient intake and growth rates, and allow earlier hospital discharge.

Objectives:

To assess the effect of a policy of feeding preterm infants on an ad libitum or demand/semi-demand basis versus feeding prescribed volumes at scheduled intervals on growth rates and the time to hospital discharge.

Search strategy:

We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2009), MEDLINE (1966 to Oct 2009), EMBASE (1980 to Oct 2009), CINAHL (1982 to Oct 2009), conference proceedings, and previous reviews.

Selection criteria:

Randomised or quasi-randomised controlled trials (including cluster randomised trials) that compared a policy of feeding preterm infants on an ad libitum or demand/semi-demand basis versus feeding at scheduled intervals.

Data collection and analysis:

We used the standard methods of the Cochrane Neonatal Review Group with separate evaluation of trial quality and data extraction by two review authors.

Main results:

We found eight randomised controlled trials that compared ad libitum or demand/semi-demand regimens with scheduled interval regimes in preterm infants in the transition phase from intragastric tube to oral feeding. The trials were generally small and of variable methodological quality. The duration of the intervention and the duration of data collection and follow-up in most of the trials was not likely to have allowed detection of measurable effects on growth. Three trials reported that feeding preterm infants using an ad libitum or demand/semi-demand feeding regimen allowed earlier discharge from hospital (by about two to four days) but other trials did not confirm this finding.

Authors' conclusions:

Limited evidence exists that feeding preterm infants with ad libitum or demand/semi-demand regimens allows earlier attainment of full oral feeding and earlier hospital discharge. This finding should be interpreted cautiously because of methodological weaknesses in the included trials. A large randomised controlled trial is needed to confirm this finding and to determine if ad libitum of demand/semi-demand feeding of preterm infants affects other clinically important outcomes.

This record should be cited as:

McCormick FM, Tosh K, McGuire W. Ad libitum or demand/semi-demand feeding versus scheduled interval feeding for preterm infants. Cochrane Database of Systematic Reviews 2010, Issue 2. Art. No.: CD005255. DOI: 10.1002/14651858.CD005255.pub3

Assessed as up to date:

December 23, 2009

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Primary Review Group:

Neonatal Group

PEARLS - Practical Evidence About Real Life Situations (click to read)

Clinical question:

How effective is ad libitum or demand/semi-demand feeding for preterm infants in the transition phase from intragastric tube to oral feeding?

Bottom line:

Three trials reported that, compared with scheduled interval feeding, an ad libitum or demand/semi-demand feeding regimen for preterm infants allowed earlier attainment of full oral feeding and earlier hospital discharge (by about 2 to 4 days). Other trials did not confirm this finding.

Caveat:

The trials were generally small and of variable methodological quality. The duration of the intervention and the duration of data collection and follow-up in most of the trials were not likely to have allowed detection of measurable effects on growth.

Context:

Scheduled interval feeding of prescribed enteral volumes is current standard practice for preterm infants. Feeding preterm infants in response to their hunger and satiation cues (ad libitum or demand/ semi demand) rather than at scheduled intervals might help in the establishment of independent oral feeding, increase nutrient intake and growth rates, and allow earlier hospital discharge.

Cochrane Systematic Review:

McCormick FM et al. Ad libitum or demand/semi-demand feeding versus scheduled interval feeding for preterm infants. Cochrane Reviews 2010, Issue 2. Article No. CD005255. DOI: 10.1002/14651858.CD005255.pub3. This review contains 8 studies involving 496 participants.

Authored by:

Brian R McAvoy

Cochrane Primary Health Care Field

Health topics:

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

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Ad libitum or demand/semi-demand feeding versus scheduled interval feeding for preterm infants

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