Effect of Extended Infusion Versus Intermittent Bolus Feedings on Hospital Weight Gain in Extremely Low Birth Weight Infants Born at <29 Weeks of Gestation: A Randomized Noninferiority Clinical Trial.
Haribalakrishna Balasubramanian, Manoj Sahoo, Darsika Chhadva et al.
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In 30 seconds
This randomized noninferiority trial compared extended milk-infusion feeding with every-2-hour intermittent bolus feeding in extremely low birth weight infants born before 29 weeks’ gestation who were starting enteral nutrition. Among 132 randomized infants, mean weight gain at discharge was 15.3 ± 2.6 g/kg/day with infusion and 15.7 ± 2.8 g/kg/day with bolus feeding; the per-protocol mean difference was -0.4 g/kg/day, with a lower one-sided 97.5% confidence limit of -1.15 g/kg/day. Extended infusion met the prespecified noninferiority criterion. Feeding interruptions were less frequent with infusion during the first 28 days.
Key findings
- Discharge weight gain was 15.3 ± 2.6 g/kg/day with infusion versus 15.7 ± 2.8 g/kg/day with bolus feeding.
- The per-protocol mean weight-gain difference was -0.4 g/kg/day; the lower one-sided 97.5% CI limit was -1.15 g/kg/day, within the noninferiority margin of -2.
- Feeding interruptions in the first 28 days were 6.7 days [5.6-8.1] versus 8.7 [7.4-10.1] per 100 patient days (P = .03), favoring infusion.
- Time to full enteral feeding, hospitalization duration, and morbidities were similar between groups.
Why it matters
Feeding strategy is a practical component of care for extremely preterm infants, and weight gain is an important hospital outcome. This trial suggests that extended infusion can achieve weight gain noninferior to intermittent bolus feeding in infants who attain early enteral feeding, while also showing fewer feeding interruptions in the first 28 days. The findings inform consideration of feeding schedules without establishing broader benefits.
What to keep in mind
The conclusion applies to infants with extremely low birth weight who achieve early enteral feedings; the abstract does not establish applicability to other populations or feeding circumstances.