Increasing incremental milk feeding volume in preterm infants offers no benefit

  • Dorling J & al.
  • N Engl J Med
  • 10 Oct 2019

  • International Clinical Digest
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Takeaway

  • Bumping the daily increment increase for milk feeding from 18 to 30 mL/kg in preterm infants born
  • Randomized controlled trial findings show no effects on infectious outcomes or death, either.

Why this matters

  • Some observational results had suggested an association of enteral feeding volume advance on risk for necrotizing enterocolitis and late-onset sepsis.

Key results

  • 1224 infants experienced the faster advance (30 mL/kg/day), and 1246 experienced the slower increment (18 mL/kg/day).
  • Survival without moderate-severe neurodevelopmental disability at age 2 years was 65.5% with the faster increment vs 68.1% with the slower approach.
    • Adjusted risk ratio (aRR): 0.96 (95% CI, 0.92-1.01).
  • Late-onset sepsis rate was 29.8% with faster increment vs 31.1% with slower (aRR, 0.96; 95% CI, 0.86-1.07).
  • Necrotizing enterocolitis rate was 5.0% in the faster group vs 5.6% in the slower group (aRR, 0.88; 95% CI, 0.68-1.16).
  • Mortality at age 2 years was 5.6% with the faster increment vs 6.2% with the slower.

Study design

  • Infants were randomly allocated to 1 of the feeding protocols, from June 8, 2013 to June 30, 2015, at 55 hospitals.
  • Funding: National Institute for Health Research.

Limitations

  • Trial was not blinded.