Continuous versus bolus nasogastric tube feeding in premature neonates: Randomized controlled trial

Abstract

Background: Whether premature infants should be fed by bolus or continuous gavage feeding, is still a matter of debate. A recent Cochrane analysis revealed no difference. Study design and methods: We carried out a randomized controlled trial in premature infants on continuous versus bolus nasogastric tube feeding, to search for differences with respect to number of incidents, growth, and time to reach full oral feeding. In total, 110 premature neonates (gestational age 27 - 34 weeks) were randomly assigned to receive either continuous or bolus nasogastric tube feeding. Basic characteristics were comparable in both groups. Results: No significant difference in weight gain could be detected between the two groups, mean weight gain amounting 151.6 (108.9 - 194.3) and 152.4 (102.2 - 202.6) grams per week in the continuous and bolus group, respectively. No significant differences were found between both groups in the time needed to achieve full oral feeding (8 oral feedings per day), full oral feeding being achieved at day 31 (range 19 - 43) and day 29 (range 18 - 40) of life in the continuous and bolus group, respectively. We also found no significant differences in the number of "incident-days" (three or more incidents a day): 3.5 (0 - 9) versus 2.7 (0 - 6.5) days in the continuous and bolus group, respectively. Conclusion: No significant differences were found in weight gain, time to achieve full oral feeding and number of incident-days between preterm infants enterally fed by nasogastric tube, according to either the bolus or continuous method.

Share and Cite:

van der Star, M. , Semmekrot, B. , Spanjaards, E. and Schaafsma, A. (2012) Continuous versus bolus nasogastric tube feeding in premature neonates: Randomized controlled trial. Open Journal of Pediatrics, 2, 214-218. doi: 10.4236/ojped.2012.23034.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Aynsley-Green, A., Adrian, T.E. and Bloom, S.R. (1982) Feeding and the development of enteroinsular hormone secretion in the preterm infant: Effects of continuous gastric infusions of human milk compared with intermittent boluses. Acta Paediatrica, 71, 379-383. doi:10.1111/j.1651-2227.1982.tb09438.x
[2] Lucas, A., Bloom, S.R. and Aynsley-Green, A. (1980) The development of gut hormone response to feeding in neonates. Archives of Disease in Childhood, 55, 678-682. doi:10.1136/adc.55.9.678
[3] Lucas, A., Bloom, S.R. and Aynsley-Green, A. (1986) Gut hormones in "minimal enteral feeding". Acta Paediatrica, 75, 719-723. doi:10.1111/j.1651-2227.1986.tb10280.x
[4] Blondheim, O., Abbasi, S., Fox, W.W. and Bhutani, V.K. (1993) Effect of enteral gavage feeding rate on pulmonary functions of very low birth weight infants. The Journal of Pediatrics, 122, 751-755. doi:10.1016/S0022-3476(06)80021-1
[5] Grant, J. and Denne, S.C. (1991) Effect of intermittent versus continuous enteral feeding on energy expenditure in premature infants. The Journal of Pediatrics, 118, 928-932. doi:10.1016/S0022-3476(05)82213-9
[6] De Ville, K., Knapp, E., Al-Tawil, Y. and Berseth, C.L. (1998) Slow infusion feedings enhance duodenal motor responses and gastric emptying in preterm infants. The American Journal of Clinical Nutrition, 68, 103-108.
[7] Dollberg, S., Kuint, J., Mazkereth, R. and Mimouni, F.B. (2000) Feeding tolerance in preterm infants: Randomized trial of bolus and continuous feeding. Journal of the American College Nutrition, 19, 797-800.
[8] Dsilna, A., Christensson, K., Alfredsson, L., Lagercrantz, H. and Blennow, M. (2005) Continuous feeding promotes gastrointestinal tolerance and growth in very low birth weight infants. The Journal of Pediatrics, 147, 43-49. doi:10.1016/j.jpeds.2005.03.003
[9] Jawaheer, G., Shaw, N.J. and Pierro, A. (2001) Continuous enteral feeding impairs gallbladder emptying in infants. The Journal of Pediatrics, 138, 822-825. doi:10.1067/mpd.2001.114019
[10] Lane, A.J.P., Coombs, R.C., Evans, D.H. and Levin, R.J. (1998) Effect of feed interval and feed type on splanchnic haemodynamics. Archives of Disease in Childhood (Fetal and Neonatal Edition), 79, F49-F53. doi:10.1136/fn.79.1.F49
[11] Macdonald, P.D., Skeoch, C.H., Carse, H., Dryburgh, F., Alroomi, L.G., Galea, P. and Gettinby, G. (1992) Randomized trial of continuous nasogastric, and transpyloric feeding in infants of birth weight under 1400 g. Archives of Disease in Childhood, 67, 429-431. doi:10.1136/adc.67.4_Spec_No.429
[12] Premji, S. and Chessell, L. (2007) Continuous nasogastric milk feeding versus intermittent bolus milk feeding for premature infants less than 1500 grams (review). The Cochrane Collaboration, John Wiley and Sons Ltd., Hoboken, 1-27. www.thecochranelibrary.com
[13] Schanler, R.J., Shulman, R.J., Lau, C., Smith, E.O. and Heitkemper, M.M. (1999) Feeding strategies for premature infants: Randomized trial of gastrointestinal priming and tube-feeding method. Pediatrics, 103, 434-439. doi:10.1542/peds.103.2.434
[14] Toce, S.S., Keenan, W.J. and Homan, S.M. (1987) Enteral feeding in very-low-birth-weight infants: A comparison of two nasogastric methods. American Journal of Diseases of Children, 141, 439-444.
[15] Akintorin, S.M., Kamat, M., Pildes, R.S., Kling, P., Andes, S., Hill, J. and Pyati, S. (1997) A prospective randomized trial of feeding methods in very low birth weight infants. Pediatrics, 100, e4. doi:10.1542/peds.100.4.e4
[16] Silvestre, M.A., Morbach, C.A., Brans, Y.W. and Shankaran, S. (1996) A prospective randomized trial comparing continuous versus intermittent feeding methods in very low birth weight neonates. The Journal of Pediatrics, 128, 748-752. doi:10.1016/S0022-3476(96)70324-4

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.