High versus standard volume enteral feeds to promote growth in preterm or low birth weight infants

Thangaraj Abiramalatha; Niranjan Thomas; Vijay Gupta; Anand Viswanathan; William McGuire

doi:10.1002/14651858.CD012413.pub2

Jumlah suapan enteral yang standard vs tinggi untuk menggalakkan pertumbuhan bayi pramatang atau berat badan rendah

Contraer todo Desplegar todo

Referencias

References to studies included in this review

Ir a:

estudios excluidos
otras referencias

Thomas N, Cherian A, Santhanam S, Jana AK. A randomized control trial comparing two enteral feeding volumes in very low birth weight babies. Journal of Tropical Pediatrics 2012;58(1):55‐8. [PUBMED: 21320855]

References to studies excluded from this review

Ir a:

estudios incluidos
otras referencias

Kuschel CA, Evans N, Askie L, Bredemeyer S, Nash J, Polverino J. A randomized trial of enteral feeding volumes in infants born before 30 weeks' gestation. Journal of Paediatrics and Child Health 2000;36(6):581‐6.

Lewis MA, Smith BA. High volume milk feeds for preterm infants. Archives of Disease in Childhood 1984;59(8):779‐81.

Valman HB, Aikens R, David‐Reed Z, Garrow JS. Retention of nitrogen, fat, and calories in infants of low birth weight on conventional and high‐volume feeds. British Medical Journal 1974;3(5926):319‐20.

Zecca E, Costa S, Barone G, Giordano L, Zecca C, Maggio L. Proactive enteral nutrition in moderately preterm small for gestational age infants: a randomized clinical trial. Journal of Pediatrics 2014;165(6):1135‐9.e1.

Additional references

Ir a:

estudios incluidos
estudios excluidos

American Academy of Pediatrics Committee on Nutrition. Nutritional needs of preterm infants. In: Kleinman RE editor(s). Pediatric Nutrition Handbook. Elk Grove Village, IL: American Academy of Pediatrics, 2004:23–54.

Agostoni C, Buonocore G, Carnielli VP, De Curtis M, Darmaun D, Decsi T, et al. Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. Journal of Pediatric Gastroenterology and Nutrition 2010;50(1):85‐91. [PUBMED: 19881390]

Arslanoglu S, Corpeleijn W, Moro G, Braegger C, Campoy C, Colomb V, et al. Donor human milk for preterm infants: current evidence and research directions. Journal of Pediatric Gastroenterology and Nutrition 2013;57(4):535‐42. [PUBMED: 24084373]

Bertino E, Giuliani F, Prandi G, Coscia A, Martano C, Fabris C. Necrotizing enterocolitis: risk factor analysis and role of gastric residuals in very low birth weight infants. Journal of Pediatric Gastroenterology and Nutrition 2009;48(4):437‐42. [PUBMED: 19330932]

Brandt I, Sticker EJ, Lentze MJ. Catch‐up growth of head circumference of very low birth weight, small for gestational age preterm infants and mental development to adulthood. Journal of Pediatrics 2003;142(5):463‐8. [PUBMED: 12756374]

Brandt I, Sticker EJ, Gausche R, Lentze MJ. Catch‐up growth of supine length/height of very low birth weight, small for gestational age preterm infants to adulthood. Journal of Pediatrics 2005;147(5):662‐8. [PUBMED: 16291360]

Brown JV, Embleton ND, Harding JE, McGuire W. Multi‐nutrient fortification of human milk for preterm infants. Cochrane Database of Systematic Reviews 2016, Issue 5. [DOI: 10.1002/14651858.CD000343.pub3]

Chawla D, Agarwal R, Deorari AK, Paul VK. Fluid and electrolyte management in term and preterm neonates. Indian Journal of Pediatrics 2008;75(3):255‐9. [PUBMED: 18376094]

Clark RH, Thomas P, Peabody J. Extrauterine growth restriction remains a serious problem in prematurely born neonates. Pediatrics 2003;111(5):986‐90. [PUBMED: 12728076]

Cooke RJ, Ainsworth SB, Fenton AC. Postnatal growth retardation: a universal problem in preterm infants. Archives of Disease in Childhood. Fetal and Neonatal Edition 2004;89(5):F428‐30. [PUBMED: 15321963]

Cormack B, Sinn J, Lui K, Tudehope D. Australasian neonatal intensive care enteral nutrition survey: implications for practice. Journal of Paediatrics and Child Health 2013;49(4):E340‐7. [PUBMED: 23227901]

Nutrition Committee, Canadian Paediatric Society. Nutrition needs and feeding of premature infants. Canadian Medical Association Journal 1995;152(11):1765‐85. [PUBMED: 7773894]

PubMed

Doege C, Bauer J. Effect of high volume intake of mother's milk with an individualized supplementation of minerals and protein on early growth of preterm infants < 28 weeks of gestation. Clinical Nutrition 2007;26(5):581‐8. [PUBMED: 17655982]

Dusick AM, Poindexter BB, Ehrenkranz RA, Lemons JA. Growth failure in the preterm infant: can we catch up?. Seminars in Perinatology 2003;27(4):302‐10. [PUBMED: 14510321]

Dutta S, Singh B, Chessell L, Wilson J, Janes M, McDonald K, et al. Guidelines for feeding very low birth weight infants. Nutrients 2015;7(1):423‐42. [PUBMED: 25580815]

Ehrenkranz RA, Younes N, Lemons JA, Fanaroff AA, Donovan EF, Wright LL, et al. Longitudinal growth of hospitalized very low birth weight infants. Pediatrics 1999;104(2 Pt 1):280‐9. [PUBMED: 10429008]

Embleton ND. Optimal protein and energy intakes in preterm infants. Early Human Development 2007;83(12):831‐7. [PUBMED: 17980784]

Embleton ND. Early nutrition and later outcomes in preterm infants. World Review of Nutrition and Dietetics 2013;106:26‐32. [PUBMED: 23428677]

Euser AM, de Wit CC, Finken MJ, Rijken M, Wit JM. Growth of preterm born children. Hormone Research 2008;70(6):319‐28. [PUBMED: 18953169]

Franz AR, Pohlandt F, Bode H, Mihatsch WA, Sander S, Kron M, et al. Intrauterine, early neonatal, and postdischarge growth and neurodevelopmental outcome at 5.4 years in extremely preterm infants after intensive neonatal nutritional support. Pediatrics 2009;123(1):e101‐9. [PUBMED: 19117831]

McMaster University (developed by Evidence Prime). GRADEproGDT [www.gradepro.org]. Version accessed 10 May 2017. Hamilton (ON): McMaster University (developed by Evidence Prime), 2015.

Hack M, Schluchter M, Cartar L, Rahman M, Cuttler L, Borawski E. Growth of very low birth weight infants to age 20 years. Pediatrics 2003;112(1 Pt 1):e30‐8. [PUBMED: 12837903]

Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. www.cochrane‐handbook.org.

Higgins RD, Devaskar S, Hay WW, Ehrenkranz RA, Greer FR, Kennedy K, et al. Executive summary of the workshop "Nutritional Challenges in the High Risk Infant". Journal of Pediatrics 2012;160(3):511‐6. [PUBMED: 22240111]

Horbar JD, Ehrenkranz RA, Badger GJ, Edwards EM, Morrow KA, Soll RF, et al. Weight growth velocity and postnatal growth failure in infants 501 to 1500 grams: 2000‐2013. Pediatrics 2015;136(1):e84‐92. [PUBMED: 26101360]

Johnston M, Landers S, Noble L, Szucs K, Viehmann L. Breastfeeding and the use of human milk. Pediatrics 2012;129(3):e827‐41. [PUBMED: 22371471]

Kler N, Thakur A, Modi M, Kaur A, Garg P, Soni A, et al. Human Milk Fortification in India. Nestle Nutrition Institute Workshop Series 2015;81:145‐51. [PUBMED: 26111571]

Klingenberg C, Embleton ND, Jacobs SE, O'Connell LA, Kuschel CA. Enteral feeding practices in very preterm infants: an international survey. Archives of Disease in Childhood. Fetal and Neonatal Edition 2012;97(1):F56‐61. [PUBMED: 21856644]

Lapillonne A, Griffin IJ. Feeding preterm infants today for later metabolic and cardiovascular outcomes. Journal of Pediatrics 2013;162(3 Suppl):S7‐16. [PUBMED: 23445851]

Leppanen M, Lapinleimu H, Lind A, Matomaki J, Lehtonen L, Haataja L, et al. Antenatal and postnatal growth and 5‐year cognitive outcome in very preterm infants. Pediatrics 2014;133(1):63‐70. [PUBMED: 24344103]

Lima PA, Carvalho MD, Costa AC, Moreira ME. Variables associated with extrauterine growth restriction in very low birth weight infants. Jornal de Pediatria 2014;90(1):22‐7. [PUBMED: 24156833]

Neubauer V, Griesmaier E, Pehbock‐Walser N, Pupp‐Peglow U, Kiechl‐Kohlendorfer U. Poor postnatal head growth in very preterm infants is associated with impaired neurodevelopment outcome. Acta Paediatrica 2013;102(9):883‐8. [PUBMED: 23772884]

Premji SS, Chessell L. Continuous nasogastric milk feeding versus intermittent bolus milk feeding for premature infants less than 1500 grams. Cochrane Database of Systematic Reviews 2011, Issue 11. [DOI: 10.1002/14651858.CD001819.pub2; PUBMED: 22071802]

Raban MS, Joolay Y, Horn AR, Harrison MC. Enteral feeding practices in preterm infants in South Africa. South African Journal of Child Health 2013;7:8‐12.

Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.

Sakurai M, Itabashi K, Sato Y, Hibino S, Mizuno K. Extrauterine growth restriction in preterm infants of gestational age ≤ 32 weeks. Pediatrics International 2008;50(1):70‐5. [PUBMED: 18279209]

Sankar MJ, Agarwal R, Mishra S, Deorari AK, Vinod PK. Feeding of low birth weight infants. Indian Journal of Paediatrics 2008;75:459‐69.

Schünemann H, Brożek J, Guyatt G, Oxman A, editors. GWG. GRADE Handbook for Grading Quality of Evidence and Strength of Recommendations. www.guidelinedevelopment.org/handbook.Updated October 2013.

Google Scholar

Shan HM, Cai W, Cao Y, Fang BH, Feng Y. Extrauterine growth retardation in premature infants in Shanghai: a multicenter retrospective review. European Journal of Pediatrics 2009;168(9):1055‐9. [PUBMED: 19096875]

Stein AD, Barros FC, Bhargava SK, Hao W, Horta BL, Lee N, et al. Birth status, child growth, and adult outcomes in low‐ and middle‐income countries. Journal of Pediatrics 2013;163(6):1740‐6.e4. [PUBMED: 24064150]

Stevens TP, Shields E, Campbell D, Combs A, Horgan M, La Gamma EF, et al. Variation in enteral feeding practices and growth outcomes among very premature Infants: a report from the New York State Perinatal Quality Collaborative. American Journal of Perinatology 2016;33(1):9‐19. [PUBMED: 26084749]

Steward DK, Pridham KF. Growth patterns of extremely low‐birth‐weight hospitalized preterm infants. Journal of Obstetric, Gynecologic, and Neonatal Nursing 2002;31(1):57‐65. [PUBMED: 11843020]

Tudehope DI. Human milk and the nutritional needs of preterm infants. Journal of Pediatrics 2013;162(3 Suppl):S17‐25. [PUBMED: 23445843]

Uhing MR, Das UG. Optimizing growth in the preterm infant. Clinics in Perinatology 2009;36(1):165‐76. [PUBMED: 19161873]

Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatric Clinics of North America 1986;33(1):179‐201. [PUBMED: 3081865]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Ir a:

estudios excluidos

Thomas 2012

Methods	RCT
Participants	64 newborn VLBW infants were enrolled when they achieved 200 mL/kg/d enteral feeds. Both appropriate‐for‐gestational‐age and small‐for‐gestational‐age infants were included. Only birth weight (not gestational age) criteria were used for enrolment
Interventions	Intervention arm (N = 32): Feeds were graded up by 20 mL/kg/d up to 300 mL/kg/d Control arm (N = 32): Feeds were continued at 200 mL/kg/d Babies in both intervention and control arms were given expressed breast milk along with individual micronutrient supplements for calcium, iron, and vitamins. Multi‐nutrient milk fortifiers, which supplement calories and proteins, were not used. Feeds were given by nasogastric tube at 2‐ to 3‐hourly intervals
Outcomes	Primary outcome: weight gain (g/kg/d) from enrolment until baby reached weight of 1700 grams Secondary outcomes: feed intolerance, tachypnoea, NEC (stage 2a or greater), bacteraemia or fungaemia, biochemical abnormalities
Notes	Setting: Neonatology Unit, Christian Medical College Hospital, Vellore (a tertiary care teaching hospital in South India) *Twelve infants in the high‐volume group did not achieve the targeted 300 mL/kg/d (although all achieved feed volumes > 250 mL/kg/d), and 6 infants in the standard‐volume group received higher volumes than targeted (up to 215 mL/kg/d), but analyses were done by "intention‐to‐treat"
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Personal communication: 'computer‐generated random sequence'
Allocation concealment (selection bias)	Low risk	Personal communication: 'sealed opaque envelopes opened by the principal investigator only at the time of allocation'
Blinding of participants and personnel (performance bias) All outcomes	High risk	Unblinded
Blinding of outcome assessment (detection bias) All outcomes	High risk	Unblinded
Incomplete outcome data (attrition bias) All outcomes	Low risk	Three (of 64) randomised infants were removed from the study by parents, did not complete the intervention, and were not included in analyses
Selective reporting (reporting bias)	Low risk	Personal communication: 'all proposed outcomes reported'
Other bias	Low risk	Nil

NEC: necrotising enterocolitis.
RCT: randomised controlled trial.
VLBW: very low birth weight.

Characteristics of excluded studies [ordered by study ID]

Ir a:

estudios incluidos

Study	Reason for exclusion
Kuschel 2000	This study compared 2 enteral feed volumes: 150 mL/kg/d and 200 mL/kg/d (both "standard" volumes)
Lewis 1984	This is a retrospective study of 87 low birth weight infants fed 250 mL/kg/d; not a randomised controlled trial
Valman 1974	This is a cohort study comparing 2 feed volumes: 180 mL/kg/d and 230 mL/kg/d; not a randomised controlled trial
Zecca 2014	This study compared 2 enteral feed volumes: 170 mL/kg/d and 200 mL/kg/d (both "standard" volumes); rate of advancement of feeds was different between groups (in 170‐mL groups, feeds were started at 60 mL/kg/d on day 1 and were advanced to full feeds on day 9; in 200‐mL group, feeds were started at 100 mL/kg/d on day 1 and were advanced to full feeds on day 4)

Data and analyses

Open in table viewer

Comparison 1. High‐volume vs standard‐volume feeds

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Weight gain (g/kg/d) Show forest plot	1	61	Mean Difference (IV, Fixed, 95% CI)	6.20 [2.71, 9.69]
Open in figure viewer Analysis 1.1 Comparison 1 High‐volume vs standard‐volume feeds, Outcome 1 Weight gain (g/kg/d).
2 Feed intolerance Show forest plot	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	1.81 [0.89, 3.67]
Open in figure viewer Analysis 1.2 Comparison 1 High‐volume vs standard‐volume feeds, Outcome 2 Feed intolerance.
3 Necrotising enterocolitis Show forest plot	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.07, 15.78]
Open in figure viewer Analysis 1.3 Comparison 1 High‐volume vs standard‐volume feeds, Outcome 3 Necrotising enterocolitis.

Figure 1

Study flow diagram.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for the included study.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 3

Forest plot of comparison: 1 High‐volume vs standard‐volume feeds, outcome: 1.1 Weight gain (g/kg/d).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 4

Forest plot of comparison: 1 High‐volume vs standard‐volume feeds, outcome: 1.2 Feed intolerance.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 5

Forest plot of comparison: 1 High‐volume vs standard‐volume feeds, outcome: 1.3 Necrotising enterocolitis.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.1

Comparison 1 High‐volume vs standard‐volume feeds, Outcome 1 Weight gain (g/kg/d).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

Comparison 1 High‐volume vs standard‐volume feeds, Outcome 2 Feed intolerance.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.3

Comparison 1 High‐volume vs standard‐volume feeds, Outcome 3 Necrotising enterocolitis.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Summary of findings for the main comparison. High‐volume feeds vs standard‐volume feeds for preterm or low birth weight infants

High‐volume feeds vs standard‐volume feeds for preterm or low birth weight infants
Patient or population: preterm or low birth weight infants Setting: neonatal care facilities Intervention: high‐volume feeds Comparison: standard‐volume feeds
Outcomes	*Anticipated absolute effects (95% CI)**		Relative effect (95% CI)	No. of participants (studies)	Quality of the evidence (GRADE)
	Risk with standard‐volume feeds	Risk with high‐volume feeds
Weight gain (g/kg/d)	Mean weight gain was 18.7 g/kg/d	Mean weight gain was 6.2 g/kg/d higher (2.71 higher to 9.69 higher)	‐	61 (1 RCT)	⊕⊕⊝⊝ LOW^a,b
Feed intolerance	Study population		RR 1.81 (0.89 to 3.67)	61 (1 RCT)	⊕⊕⊝⊝ LOW^a,b
	258 per 1000	467 per 1000 (230 to 947)
Necrotising enterocolitis	Study population		RR 1.03 (0.07 to 15.78)	61 (1 RCT)	⊕⊝⊝⊝ VERY LOW^a,c
	32 per 1000	33 per 1000 (2 to 509)
*Risk in the intervention group (and its 95% CI) is based on assumed risk in the comparison group and relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio.
^aDowngraded for risk of bias (lack of blinding). ^bDowngraded for imprecision. ^cDowngraded (by 2) for serious imprecision.

Summary of findings for the main comparison. High‐volume feeds vs standard‐volume feeds for preterm or low birth weight infants

Ir a la tabla de la revisión

Table 1. Typical energy and protein content of human milk or formula

per 100 mL

Expressed breast milk

(EBM)

EBM

+ Fortifier

Term formula

Preterm formula

Energy (kCal)

67

74 to 80

67

80

Protein (g)

1.2 to 1.7

2.0 to 2.5

1.5

2.4

Table 1. Typical energy and protein content of human milk or formula

Ir a la tabla de la revisión

Comparison 1. High‐volume vs standard‐volume feeds

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Weight gain (g/kg/d) Show forest plot	1	61	Mean Difference (IV, Fixed, 95% CI)	6.20 [2.71, 9.69]

2 Feed intolerance Show forest plot	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	1.81 [0.89, 3.67]

3 Necrotising enterocolitis Show forest plot	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.07, 15.78]

Comparison 1. High‐volume vs standard‐volume feeds

Ir a la tabla de la revisión

	Idioma de la Revisión Cochrane Escoja su idioma de preferencia para las revisiones Cochrane y otros contenidos. Las secciones sin una traducción aparecerán en inglés.

	Idioma de la web Escoja su idioma de preferencia para la web de la Biblioteca Cochrane.

Idioma de la Revisión Cochrane

Idioma de la web

Referencias

References to studies included in this review

Thomas 2012 {published data only}

References to studies excluded from this review

Kuschel 2000 {published data only}

Lewis 1984 {published data only}

Valman 1974 {published data only}

Zecca 2014 {published data only}

Additional references

AAP 2004

Agostoni 2010

Arslanoglu 2013

Bertino 2009

Brandt 2003

Brandt 2005

Brown 2016

Chawla 2008

Clark 2003

Cooke 2004

Cormack 2013

CPS 1995

Doege 2007

Dusick 2003

Dutta 2015

Ehrenkranz 1999

Embleton 2007

Embleton 2013

Euser 2008

Franz 2009

GRADEproGDT [Computer program]

Hack 2003

Higgins 2011

Higgins 2012

Horbar 2015

Johnston 2012

Kler 2015

Klingenberg 2012

Lapillonne 2013

Leppanen 2014

Lima 2014

Neubauer 2013

Premji 2011

Raban 2013

Review Manager 5 [Computer program]

Sakurai 2008

Sankar 2008

Schünemann 2013

Shan 2009

Stein 2013

Stevens 2016

Steward 2002

Tudehope 2013

Uhing 2009

Walsh 1986

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [ordered by study ID]

Data and analyses

Copiar o descargar referencia

Idioma de la Revisión Cochrane

Idioma de la web

Instituciones a las que se accedió previamente

Usuarios institucionales

Instituciones a las que se accedió previamente

Otras opciones de acceso