Feeding strategies for premature infants: Randomized trial of gastrointestinal priming and tube-feeding method

Background Data on enteral feeding management of premature infants are limi ted and often not the subject of randomized clinical trials. Several small studies suggest benefits from the early initiation of feeding, but do not a ssess the combined effects of time of initiation of feeding, tube-feeding m ethod and type of milk used. Either singly or in combination, these treatme nts may affect growth, bone mineralization, biochemical measures of nutriti onal status, and feeding tolerance, and, ultimately, the duration of hospit alization. Methods. A total of 171 premature infants, stratified by gestational age (2 6 to 30 weeks) and diet (human milk or preterm formula) were assigned rando mly among four treatment combinations in a balanced two-way design comparin g the presence or absence of gastrointestinal (GI) priming for 10 days and continuous infusion versus intermittent bolus tube-feeding. Results. The major outcome, time required for infants to attain full oral f eeding, was similar among treatments. GI priming was not associated with an y measured adverse effect and was associated with better calcium and phosph orus retention, higher serum calcium and alkaline phosphatase activity, and shorter intestinal transit times. The bolus tube-feeding method was associ ated with significantly less feeding intolerance and greater rate of weight gain than the continuous method. In addition, the greater the quantity of human milk fed, the lower the morbidity. Conclusions. Early GI priming with human milk,using the bolus tube-feeding method, may provide the best advantage for the premature infant.