In the Journals

Speed of increasing milk feeds does not affect neurodevelopmental outcomes in preterm infants

Preterm and very low-birth-weight infants fed in faster and slower increments had comparable neurodevelopmental outcomes at age 24 months, according to findings from a randomized controlled trial published in The New England Journal of Medicine.

The Speed of Increasing Milk Feeds Trial (SIFT) also showed no difference in the two feeding strategies’ effect on the risks for late-onset sepsis or necrotizing enterocolitis.

“Observational studies have shown a higher risk for necrotizing enterocolitis with rapid advancement of feeding volumes but are subject to bias; one was an uncontrolled study before and after the introduction of a slowly progressive tube-feeding schedule, and two were small case-control studies,” Jon Dorling, MD, division head of neonatal-perinatal medicine and professor of pediatrics at Dalhousie University in Nova Scotia, and colleagues wrote.

“Slower advances in feeding volume might, however, increase the risk of late-onset sepsis from longer exposure to parenteral feeding, as shown in a meta-analysis that also revealed no increase in necrotizing enterocolitis. These conditions are both major causes of death and illness, including adverse neurodevelopmental outcomes,” they wrote.

From June 8, 2013, to June 20, 2015, Dorling and colleagues recruited 2,804 infants from 55 hospitals with a gestational age of less than 32 weeks or with a birth weight of less than 1,500 g — or both. Infants received either 30 mL of milk per kg of body weight (faster feeding) or 18 mL of milk per kg (slower feeding) until they reached full feeding volume. Of these infants, Dorling and colleagues assessed outcomes for 1,224 infants receiving faster feedings and 1,246 receiving slower feedings.

They found that 65.5% of infants fed faster and 68.1% of infants who received slower feedings survived without moderate or severe neurodevelopmental disability at age 24 months (adjusted risk ratio [aRR] = 0.96; 95% CI, 0.92-1.01).

They observed late-onset sepsis in 29.8% of infants in the faster increment group compared with 31.1% in the slower increment group (aRR = 0.96; 95% CI, 0.86-1.07). A similar percentage of infants in the faster and slower increment group experienced necrotizing enterocolitis (5% vs. 5.6%; aRR = 0.88; 95% CI, 0.68-1.16).

When the researchers examined types of disability, the only condition with a significant difference between groups was moderate or severe motor impairment, with 7.5% of infants in the faster feeding group and 5% of those in the slower feeding group diagnosed with the condition (aRR = 1.48; 99% CI, 1.02-2.14).

“Although these feeding outcomes seem to favor faster increments, the risk for moderate or severe motor impairment was unexpectedly higher in the faster-increment group than in the slower-increment group,” Dorling and colleagues wrote. “This observation is unexplained, and there were not more cases of late-onset sepsis or necrotizing enterocolitis in the faster-increment group. It is possible that it is a chance finding, since it was one of multiple secondary outcomes assessed, but biologically plausible explanations include increased cardiorespiratory events from pressure on the diaphragm or inability to absorb enteral nutrition.” – by Katherine Bortz

Disclosures: Dorling reports receiving grants and contracts from the National Institute for Health Research for the SIFT trial and other research studies. He also reports consulting for Nutrinia. Please see the study for all other authors’ relevant financial disclosures.

Preterm and very low-birth-weight infants fed in faster and slower increments had comparable neurodevelopmental outcomes at age 24 months, according to findings from a randomized controlled trial published in The New England Journal of Medicine.

The Speed of Increasing Milk Feeds Trial (SIFT) also showed no difference in the two feeding strategies’ effect on the risks for late-onset sepsis or necrotizing enterocolitis.

“Observational studies have shown a higher risk for necrotizing enterocolitis with rapid advancement of feeding volumes but are subject to bias; one was an uncontrolled study before and after the introduction of a slowly progressive tube-feeding schedule, and two were small case-control studies,” Jon Dorling, MD, division head of neonatal-perinatal medicine and professor of pediatrics at Dalhousie University in Nova Scotia, and colleagues wrote.

“Slower advances in feeding volume might, however, increase the risk of late-onset sepsis from longer exposure to parenteral feeding, as shown in a meta-analysis that also revealed no increase in necrotizing enterocolitis. These conditions are both major causes of death and illness, including adverse neurodevelopmental outcomes,” they wrote.

From June 8, 2013, to June 20, 2015, Dorling and colleagues recruited 2,804 infants from 55 hospitals with a gestational age of less than 32 weeks or with a birth weight of less than 1,500 g — or both. Infants received either 30 mL of milk per kg of body weight (faster feeding) or 18 mL of milk per kg (slower feeding) until they reached full feeding volume. Of these infants, Dorling and colleagues assessed outcomes for 1,224 infants receiving faster feedings and 1,246 receiving slower feedings.

They found that 65.5% of infants fed faster and 68.1% of infants who received slower feedings survived without moderate or severe neurodevelopmental disability at age 24 months (adjusted risk ratio [aRR] = 0.96; 95% CI, 0.92-1.01).

They observed late-onset sepsis in 29.8% of infants in the faster increment group compared with 31.1% in the slower increment group (aRR = 0.96; 95% CI, 0.86-1.07). A similar percentage of infants in the faster and slower increment group experienced necrotizing enterocolitis (5% vs. 5.6%; aRR = 0.88; 95% CI, 0.68-1.16).

When the researchers examined types of disability, the only condition with a significant difference between groups was moderate or severe motor impairment, with 7.5% of infants in the faster feeding group and 5% of those in the slower feeding group diagnosed with the condition (aRR = 1.48; 99% CI, 1.02-2.14).

“Although these feeding outcomes seem to favor faster increments, the risk for moderate or severe motor impairment was unexpectedly higher in the faster-increment group than in the slower-increment group,” Dorling and colleagues wrote. “This observation is unexplained, and there were not more cases of late-onset sepsis or necrotizing enterocolitis in the faster-increment group. It is possible that it is a chance finding, since it was one of multiple secondary outcomes assessed, but biologically plausible explanations include increased cardiorespiratory events from pressure on the diaphragm or inability to absorb enteral nutrition.” – by Katherine Bortz

Disclosures: Dorling reports receiving grants and contracts from the National Institute for Health Research for the SIFT trial and other research studies. He also reports consulting for Nutrinia. Please see the study for all other authors’ relevant financial disclosures.