A PROSPECTIVE RANDOMIZED TRIAL OF FEEDING METHODS IN VERY-LOW-BIRTH-WEIGHT INFANTS

Objective. To test the hypothesis that very low birth weight infants f ed by continuous nasogastric gavage (CNG) would achieve full enteral f eedings (100 kcal/kg/d) at an earlier postnatal age and have less feed ing intolerance (FI) than infants fed by intermittent bolus gavage (IB G). Methods. Eighty infants were stratified by birth weight (700 to 10 00 g and 1001 to 1250 g) and randomized into CNG or IBG feeding groups . CNG infants were comparable with IBG in birth weight, gestational ag e, sex, race, and day of onset of feeding (5.7 +/- 2.1 days vs 5.6 +/- 2.2 days, respectively). Feedings were given as undiluted Similac Spe cial Care formula (Ross Laboratories, Columbus, OH) via a specific pro tocol designed for each 50 to 100 g birth weight category. Feedings we re advanced isoenergetically by a maximum of 25 mL/kg/d until an endpo int of 100/kcal/kg/d for at least 48 hours was reached. An infant whos e feedings were withheld for >12 hours based on predetermined criteria was considered to have an episode of FI. Results. Infants in the CNG group reached full enteral feeding at 17.1 +/- 8.9 days compared with 15.5 +/- 5.5 days in the IBG group; these were not statistically diffe rent. Secondary outcome variables such as days to regain birth weight (CNG, 12.6 +/- 5 days vs IBG, 12.5 +/- 3.7 days), days to reach discha rge weight of 2040 g (CNG, 60+/- 13.4 days vs IBG, 62 +/- 13.6 days), and number of episodes of FI were not significantly different between feeding methods. FI was primarily associated with birth weight less th an or equal to 1000 g (71%) vs 1001 to 1250 g (38%). Conclusion. Feedi ng methods are associated with similar outcomes when feeding regimens are comparable.