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Early milk feeds safe, beneficial in preterm growth-restricted babies

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – It’s safe and beneficial to start small volumes of milk feeds early, between 24 and 48 hours after birth, in babies who are both preterm and growth-restricted, as long as they are not clinically sick and unstable, according to a large study conducted in 54 hospitals in the United Kingdom and Ireland.

The study involved 404 infants born before 35 weeks gestation, birth weight below the 10th centile, and abnormal antenatal Doppler studies indicative of intrauterine growth restriction. Half commenced enteral feeds on day two after birth and the other half on day six after birth.

In the May issue of Pediatrics, available online now, the researchers report that babies in the early group achieved full sustained enteral feeding sooner than babies in the late group (median age was 18 days compared with 21 days; hazard ratio 1.36).

“Starting earlier allowed the babies to achieve full milk feeding earlier, reducing the need for intravenous nutrition by an average of three days,” first author Dr. Alison Leaf, from the Biomedical Research Centre for Nutrition, Diet and Lifestyle, University of Southampton and Southampton General Hospital in the United Kingdom, noted in an email to Reuters Health.

It’s been her experience, she said, that “with support and encouragement, the majority of mothers will be able to provide some breast milk for their baby within 24-48 hours of birth.”

Dr. Leaf also noted that “early feeding was not associated with an increase in serious intestinal complications, in particular necrotising enterocolitis.” In the study, the number of episodes of all-stage NEC was 36 (18%) in the early group and 30 (15%) in the late group (RR 1.20; p=0.42). The incidence of stage 2 and 3 NEC, “which is of greater clinical importance,” was 8% in both groups, the investigators say.

More infants in the early group had at least one episode of “abdominal pathology;” 59 (29%) vs 42 (21%; RR 1.40). This was mainly due to a higher rate of dysmotility, meconium plug, and stage 1 NEC. “There were no between-group differences in the number of infants with septic ileus, intestinal perforation, surgery, or death as a result of gastrointestinal complications,” the researchers report.

Cholestatic jaundice was less common in the early group than the late group (13% vs 22%; RR 0.58), as was the incidence of late onset sepsis (28% vs 35%; RR 0.80) – but the difference was not statistically significant.

There was no difference in the overall time spent in the hospital or ICU and early feeding led to improved SD score for weight at discharge.

Summing up, the authors say, “Our trial revealed no evidence of benefit in delaying the introduction of small volumes of enteral feeds in preterm, IUGR infants beyond 24 to 48 hours.”

In an email to Reuters Health, Dr. Paraskevi Karagianni, from the neonatology department, Aristotle University of Thessaloniki in Greece, who was a reviewer on the study, noted that the results are “largely confirmatory of other studies.”

Dr. Leaf told Reuters Health, “Hospitals vary in their approach to feeding – some hospitals may already start milk feeds quite early. For those who have a policy of delaying introduction of milk feeds, our research would support a change of practice, moving to earlier introduction of milk feeds. It is good if this can be done together with a programme of early lactation support for mothers of preterm infants.”

“The challenge now is to understand how best to progress to feeds to support healthy maturation and function of the immature gut while minimizing excessive and harmful inflammation,” the authors conclude in their paper.

This study was funded by children’s charity Action Medical Research.

SOURCE: Pediatrics 2012;129.