Arch Dis Child Fetal Neonatal Ed 2000;82:F29-F33 ( January )

Randomised controlled study of clinical outcome following trophic feeding

R J McClure, Simon J Newell

Regional Neonatal Intensive Care Unit, St James's University Hospital, Leeds

Correspondence to: Dr R J McClure, Neonatal Services, Rosie Hospital, Addenbrooke's NHS Trust, Cambridge CB2 2QQ Email: rob.mcclure{at}msexc.addenbrookes.anglox.nhs.uk

Accepted 23 June 1999

AIMSTo determine the effect of trophic feeding on clinical outcome in ill preterm infants.
METHODSA randomised, controlled, prospective study of 100 preterm infants, weighing less than 1750 g at birth and requiring ventilatory support and parenteral nutrition, was performed. Group TF (48 infants) received trophic feeding from day 3 (0.5-1 ml/h) along with parenteral nutrition until ventilatory support finished. Group C (52 infants) received parenteral nutrition alone. "Nutritive" milk feeding was then introduced to both groups. Clinical outcomes measured included total energy intake and growth over the first six postnatal weeks, sepsis incidence, liver function, milk tolerance, duration of respiratory support, duration of hospital stay and complication incidence.
RESULTSGroups were well matched for birthweight, gestation and CRIB scores. Infants in group TF had significantly greater energy intake, mean difference 41.4 (95% confidence interval 9, 73.7) kcal/kg p=0.02; weight gain, 130 (CI 1, 250) g p = 0.02; head circumference gain, mean difference 0.7 (CI 0.1, 1.3) cm, p = 0.04; fewer episodes of culture confirmed sepsis, mean difference 0.7 (1.3, 0.2) episodes, p = 0.04; less parenteral nutrition, mean difference 11.5 (CI 20, 3) days, p = 0.03; tolerated full milk feeds (165 ml/kg/day) earlier, mean difference 11.2 (CI 19, 3) days, p = 0.03; reduced requirement for supplemental oxygen, mean difference 22.4 (CI41.5, 3.3) days, p = 0.02; and were discharged home earlier, mean difference 22.1 (CI 42.1, 2.2) days, p = 0.04. There was no significant difference in the relative risk of any complication.
CONCLUSIONSTrophic feeding improves clinical outcome in ill preterm infants requiring parenteral nutrition.

Key messages Timing of the introduction of milk feeds in sick low birthweight infants is controversial. Almost all infants with non-surgical illness can tolerate at least some milk as trophic feeds. Trophic feeding leads to improved energy intake, weight gain, milk tolerance, less sepsis and earlier hospital discharge. No increase in major complication rate is seen following trophic feeding.

Keywords: trophic feeding; enteral nutrition; parenteral nutrition; infant; low birthweight

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© 2000 by Archives of Disease in Childhood
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