Early Total vs Conventional Feeding between 27-32 weeks’ gestation: A Randomized Controlled Trial

Introduction To compare the time of attainment of full enteral feeds in sick neonates between 27-32 weeks of gestation receiving early total enteral feeding (ETEF) versus conventional enteral feeding (CEF). Methods In this randomized controlled trial, 183 infants were allocated to either the ETEF (n=90) or CEF (n=93) group. In the ETEF group, feeding was initiated as complete enteral feeds, whereas in the CEF group, feeding was initiated as trophic feeding at 20 ml/kg. The rest of the day's requirements for the CEF group were provided as intravenous fluids. Results The ETEF group infants had marginally higher mean birth weight, slightly greater gestational age, fewer infants with SGA at birth, and a lesser need for resuscitation, although these differences were not statistically significant. The neonates in the ETEF group reached full enteral feeds significantly earlier than the CEF group (6.8 ± 1.8 vs. 9.1 ± 4.3 days postnatal age; mean difference -2.3 [-3.2 to -1.3]; p < 0.001). There was a significant reduction in the episodes of feed intolerance and clinical or probable sepsis with significantly higher weight gain at 1 month of age (17.4 vs 15.5 g/kg/d, p 0.001), and a shorter duration of hospital stay (25.9 vs. 38.1 days; p 0.001) in the ETEF as compared to the CEF group. None of the neonates in the ETEF group developed necrotising enterocolitis (NEC). Conclusion Early total enteral feeding in sick neonates between 27-32 weeks' gestation leads to early attainment of full feeds without increasing the incidence of feed intolerance and NEC. This feeding practice also reduces prematurity-associated complications and the duration of hospital stay.