Risk factors associated with feed intolerance in very low birthweight infants following initiation of enteral feeds during the first 72 hours of life

A systematic review of the definitions and prevalence of feeding intolerance in preterm infants

BACKGROUND & AIMS

Feeding intolerance (FI) is a common phenomenon experienced in preterm infants in neonatal intensive care units, as well as being a focus of many research studies into feeding methods, particularly in relation to comorbidities. There is no widely accepted definition of FI. This systematic review aimed to explore the range of definitions used for FI and provide an estimate of the prevalence amongst preterm infants.

METHODS

Searches were completed on MEDLINE (includes the Cochrane library), Embase, PsycInfo, CINAHL, NHS Evidence and Web of Science. Inclusion criteria; preterm infants in neonatal units, a clear definition of FI, >10 patients and be available in English language. Case reports were excluded.

RESULTS

One hundred studies were included. Definitions of FI were inconsistent. Studies were grouped according to definition used into: Group A - measuring gastric residual volume (GRV) only; group B - GRV and abdominal distension (AD); group C - GRV, AD and gastrointestinal symptoms (GI) which included any of vomiting, bilious vomiting and blood in stool; group D- GRV and GI; group E - AD and GI; group F - GI only and group G - any other elements used. Meta-analysis demonstrated that prevalence of FI between groups varied from 15 to 30% with an overall prevalence of 27% (95% confidence interval 23-31%). Group A had the highest prevalence. Review of time to full enteral feed was performed (37 studies) which demonstrated a range of 11.3-18.3 days depending on which FI definition used.

DISCUSSION

Definitions of FI in research are inconsistent, a similar finding to that seen in studies in both paediatric and adult critical care populations. The difficulty of defining FI in the preterm population is the concern regarding necrotising enterocolitis, with some studies using an overlap in their definitions, despite differing pathophysiology and management. Due to the heterogeneity of data obtained in this review regarding definitions used, further robust research is required in order to conclude which elements which should be used to define FI in this population.

PROSPERO NUMBER

CRD42019155596. Registered November 2019.

Characteristics and risk factors for extrauterine growth retardation in very-low-birth-weight infants

BACKGROUND

To investigate the characteristics and risk factors for extrauterine growth retardation (EUGR) in very-low-birth-weight infants (VLBWIs).

METHODS

The medical records of 137 VLBWIs admitted to the neonatal intensive care unit between June 2015 and December 2017 were retrospectively reviewed. The patients were divided into EUGR (n = 92) and non-EUGR (n = 45) groups. This study collected data on demographic and clinical characteristics and analyzed the risk factors for EUGR with multivariate logistic regression.

RESULTS

Gestational age (OR = 0.573, P < .01), SGA (OR = 3.887, P = .022), feeding intolerance (OR = 4.632, P = .002), and calories supplied by amino acids at the 7th day (OR = 0.786, P = .006) were high-risk factors for EUGR.

CONCLUSION

Feeding intolerance reduction and amino acid nutrition support should be applied to prevent delayed extrauterine growth for VLBWIs.

Abdominal circumference or gastric residual volume as measure of feed intolerance in VLBW infants

BACKGROUND

The aim of the study was to compare prefeed abdominal circumference (AC) and gastric residual volume (GRV) as a measure of feed intolerance in very-low-birth-weight infants (VLBW).

METHODS

Eighty VLBW infants were randomized to 2 groups; feed intolerance was monitored by measuring either GRV group or prefeed AC group. The primary outcome was time to full enteral feeds (180 mL · kg · day). Other main outcome measures were feed interruption days, duration of parenteral nutrition, incidence of culture positive sepsis, necrotizing enterocolitis, mortality, and duration of hospital stay.

RESULTS

The median (interquartile range) time to achieve full feeds was 10 (9-13) versus 14 (12-17.5) days in AC and GRV groups, respectively (P < 0.001). Infants in AC group had fewer feed interruption days (0 [0-2] vs 2.0 [1, 5], P < 0.001) and shorter duration of parenteral nutrition (P < 0.001). The incidence of culture-positive sepsis in AC and GRV groups was 17.5% and 30 %, respectively (P = 0.18). Duration of hospital stay and mortality were comparable in both the groups.

CONCLUSIONS

Prefeed AC as a measure of feed intolerance in VLBW infants may shorten the time taken to achieve full feeds.

A randomised controlled trial of two feeding schedules in neonates weighing <or=1750 g

OBJECTIVES

To study the incidence of feed intolerance, apnea and hypoglycemia in neonates weighing <or=1750 g given 3 hourly feeds as against 2 hourly feeds.

METHODS

Ninety-two neonates, weighing <or=1750 g and medically fit to receive feeds, were randomised to receive feeds either at 3 hourly or 2 hourly intervals.

RESULTS

The incidence of feed intolerance was not different between 3 hourly and 2 hourly feeding groups [13%vs. 19%, OR 0.69 (95% CI 0.19-2.49)]. The incidence of apnea was 25 and 28%[OR 0.86 (95% CI 0.3-2.48)] and that of hypoglycemia was 21 and 26%[OR 0.75 (95% CI 0.24-2.3)] in 3 hourly and 2 hourly feeding groups, respectively. The incidence of necrotising enterocolitis was also similar (7%) in both the feeding groups. The total nursing time spent on feeding per day was significantly less in 3 hourly group.

CONCLUSIONS

In comparison to a 2 hourly schedule, a 3 hourly feeding schedule did not decrease the incidence of feed intolerance; it, however, did not increase the incidence of hypoglycemia or apnea. For practical convenience, a 3 hourly feeding schedule may be preferred over 2 hourly schedule in neonates weighing <or=1750 g.