Feeding tolerance in preterm infants: Randomized trial of bolus and continuous feeding

Objective: To test the hypothesis that continuous gastric infusion (CGI) is better tolerated than intermittent gastric bolus (IGB) in small very low b irth weight (VLBW) infants. Design: Two-center, prospective, randomized, unmasked clinical trial. Patients: 28 VLBW infants (birth weight <1250 g). A strict feeding protocol was followed. Intervention: Patients were randomized to IGB or CGI. Main outcome measures: Time to reach full feeds (160 cc/kg/d)(by design and real), daily weight, caloric intake, residual gastric volume and type of f eeding (formula vs, human milk vs. both). Results: Five infants failed to complete the study because of death (n = 4) or protocol violation (n = 1). The two groups did not differ by birth weig ht or gestational age: infants fed via IGB reached full feeds earlier (p = 0.03) and had less delay in reaching full feeds than infants fed via CGI. Conclusion: Contrary to our hypothesis, gravity IGB is more effective than CGI in improving feeding tolerance in small VLBW infants.