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Published online December 1, 2004
PEDIATRICS Vol. 114 No. 6 December 2004, pp. 1597-1600 (doi:10.1542/peds.2004-1232)
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Randomized, Controlled Trial of Slow Versus Rapid Feeding Volume Advancement in Preterm Infants

Judith Caple, RNC, MSN, NNP, Debra Armentrout, RNC, MSN, NNP, Valerie Huseby, RNC, MSN, NNP, Brenda Halbardier, RNC, MSN, NNP, Jose Garcia, MD, John W. Sparks, MD, Fernando R. Moya, MD

From the Department of Pediatrics, University of Texas–Houston Medical School, Houston, Texas

Objectives. To determine whether infants who are fed initially and advanced at 30 mL/kg per day (intervention) take fewer days to get to full feedings than those who are fed initially and advanced at 20 mL/kg per day (control), without increasing their incidence of feeding complications and necrotizing enterocolitis (NEC). We also examined whether these infants regain birth weight earlier, have fewer days of intravenous fluids, and a have shorter hospital stay.

Methods. A randomized, controlled, single-center trial was conducted in a Neonatal Intensive Care Unit of a community-based county hospital in Houston, Texas. Infants between 1000 and 2000 g at birth, gestational age ≤35 weeks, and weight appropriate for gestational age were allocated randomly to feedings of expressed human milk or Enfamil formula starting and advanced at either 30 mL/kg per day or 20 mL/kg per day. Infants remained in the study until discharge or development of stage ≥IIA NEC.

Results. A total of 155 infants were enrolled: 72 infants in the intervention group and 83 in the control group. Infants in the intervention group achieved full-volume feedings sooner (7 vs 10 days, median), regained birth weight faster (11 vs 13 days, median), and had fewer days of intravenous fluids (6 vs 8 days, median). Three infants in the intervention group and 2 control infants developed NEC for an overall incidence of 3.2% (relative risk: 1.73; 95% confidence interval: 0.30–10.06).

Conclusion. Among infants between 1000 and 2000 g at birth, starting and advancing feedings at 30 mL/kg per day seems to be a safe practice and results in fewer days to reach full-volume feedings than using 20 mL/kg per day. This intervention also leads to faster weight gain and fewer days of intravenous fluids.

Key Words: enteral feedings • newborn • necrotizing enterocolitis

Abbreviations: NEC, necrotizing enterocolitis • EHM, expressed human milk • NPO, nothing by mouth

Accepted Jun 17, 2004.


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