Survival of very low birth weight neonates initiated on early versus late enteral feeding at the University Teaching Hospital, Lusaka

Abstract

Background: In most neonatal intensive care units (NICUs), including the NICU at University Teaching Hospital (UTH), Lusaka, initiation of enteral feeds in very low birth weight (VLBW) neonates, is predominantly delayed for forty-eight to seventy-two hours, whilst they are commenced on intravenous fluids containing 10% dextrose. However, a proportion of stable VLBW neonates are fed. Delayed feeding presents challenges like low blood sugar in neonates, whereas early feeding can predispose them to necrotising enterocolitis (NEC). Thus a study to compare outcomes of early versus late feeding in this group was under taken. Objective: To compare the mortality, occurrence of NEC and associated risk factors among VLBW neonates initiated on feeds early versus late. Methods: This was a cohort study comparing outcomes between VLBW infants fed breast milk late or early during the period May to October 2014 in NICU at UTH. Patients were assigned to the feeding arms based on the clinical judgement of the attending doctor. Clinical parameters of those infants enrolled in the study were obtained from clinical notes and the patients were followed up to 28 days of life. The primary outcomes were death and occurrence of NEC. We compared risks of death or NEC in the late vs. early feeders. Results: One hundred and forty eight new-borns were enrolled; 93 (63%) were girls and 55 (37%) were boys. The mean birth weight was 1.3kg. There was a total of 41 (30%) deaths recorded in this study, 35 (66%) occurred in the late feeders and 6 (6%) in the early feeders. There were 5 (3%) cases of NEC in the study, four were from the early feeders and one from the late feeders, three died (2= early feeders, 1=late feeder). Feeding status and birth weight were the only significant predictors of mortality. Conclusion: Early feeding of very low birth weight neonates is associated with better survival than late feeding. Recommendations: Early feeding of VLBW neonates in NICU, UTH will improve their survival. Randomised controlled trials need to be done to generate stronger evidence based conclusions. Keywords: early feeding, timing, very low-birth-weight, necrotising enterocolitis, survival