PURPOSE: There is a need to standardize feeding initiation and advancement in the very low birth-weight and extremely low birth-weight infant. The purpose of this study was to determine whether improvements in feeding advancement and growth were achieved without adverse outcomes after integration of evidence-based protocols into practice.
PARTICIPANTS: Infants born weighing 1250 g or less and with 32 weeks' gestational age (GA) or less who were cared for in a level III neonatal intensive care unit (NICU) at the time of feeding initiation throughout advancement to full feedings were included. Sixteen infants born between September 2006 and January 2007 (group 1) were compared with 24 infants born between October 2005 and February 2006 (group 2).
METHODS: A prospective chart review was completed after introduction of the newest protocol, Minimal Enteral Feeding (MEF), a trophic feeding protocol for infants with less than 28 weeks' GA. Birth weight (BW), GA, age at feeding initiation, age at full feedings, rate of necrotizing enterocolitis (NEC), number of days NPO, and weight gain during feeding advancement were compared with results obtained from a retrospective chart review completed in February 2006. Infants were striated into BW groups (<1000 and >=1000-1250 g). Data were compared using analysis of variance, independent t tests, and Mann-Whitney U tests.
MAIN OUTCOMES MEASURES: No differences were observed between groups 1 and 2 in GA (27.5 vs 28.1 weeks; F = 0.690; P = .41) or BW (1031 vs 1084 g; F = 0.485; P = .5). Initiation of feedings, NEC rate, and weight gain were the primary outcomes measures.
PRINCIPAL RESULTS: Feedings were started significantly sooner in group 1 than in group 2 (2.8 vs 5.1 days of life; P = .05). A trend for few days NPO in infants in group 1 for both BW groups was observed. Incidence of NEC was stable at 5.8% in 2006 versus 5.0% in 2005, although there were no cases of NEC during the last quarter of 2006 when the MEF protocol was introduced. Clinically, there was steady improvement in mean weight gain during feeding advancement since the first standardized feeding protocols were introduced into the NICU (20.7 vs 11.2 g/d).
CONCLUSIONS: The MEF protocol promoted earlier initiation of feedings in extremely premature infants with a trend for fewer interruptions in feedings. Standardized protocols provided a consistent approach to feeding. Together they were associated with improved growth during feeding advancement and less interruption in feeding without increasing risk of NEC. Because of small sample size, statistical analysis was limited. Results of this study are supportive of the use of evidence-based protocols to standardize an NICU approach to feeding initiation and advancement.