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Continuous Versus Bolus Feeding
Continuous Enteral Feeding Impairs Gallbladder Emptying in Infants. J Pediatr 2001 (June); 138: 822-5.
A prospective crossover study was performed in 15 infants: (1) bolus enteral feeds were given in phase A, (2) a continuous milk feed was given for 3 days in phase B, and (3) bolus feeds were resumed in phase C. The gallbladder was studied with ultrasonography in phase A, on days 1 and 3 of phase B, and at the start and on days 2 and 4 of phase C.
Results. Baseline volume of the gallbladder was 116.1 mm3 (range, 48.1–374.8 mm3 ) in phase A, and 293.3 mm3 (range, 109-1134.9 mm3 ) (p < 0.001) after 3 days of phase B; it returned to phase A value after 4 days of phase C. The contraction index was 65.2% (range, 40.6% - 78.2%) in phase A and 1.7% (range, 0% - 8.4%) (p < 0.001) after 3 days of phase B. It returned to its phase A value immediately after bolus enteral feeds were resumed in phase C.
Comment. This study was done on preterm babies with a median EGA of 29 weeks (range 26-37 weeks), birth weight 1.18 kg (range 0.58 – 2.44 kg), postnatal age 18 days (range 4 – 46 days). All infants were receiving full enteral feeds at the time of the study with a median caloric intake of 125 kcal/kg/d). There seems to be little question that the gallbladder contracts better after bolus feedings in these babies. The mechanism appears to be related to a decreased release of cholecystokinin with continuous feedings, and other studies have demonstrated decreased plasma levels of this hormone in children receiving continuous TPN or enteral nutrition. The authors mentioned another study (in adults) which concluded that intestinal motility is also decreased with continuous enteral nutrition. It seems that humans are meant to be "meal-eaters", and are not well adapted to continuous infusion of nutrients.