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Mark Hudak MD, Contributing Editor
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Rapid Feeding Advancement
Objectives. To determine whether infants who are fed initially and advanced at 30 mL/kg per day (intervention) take fewer days to get to full feedings than those who are fed initially and advanced at 20 mL/kg per day (control), without increasing their incidence of feeding complications and necrotizing enterocolitis (NEC). We also examined whether these infants regain birth weight earlier, have fewer days of intravenous fluids, and a have shorter hospital stay.
Methods. A
randomized, controlled, single-center trial was conducted in a
Neonatal Intensive Care Unit of a community-based county hospital in
Houston, Texas. Infants between 1000 and 2000 g at birth, gestational
age 
35
weeks, and weight appropriate for gestational age were allocated
randomly to feedings of expressed human milk or Enfamil formula
starting and advanced at either 30 mL/kg per day or 20 mL/kg per day.
Infants remained in the study until discharge or development of stage 
IIA
NEC.
Results. A total of 155 infants were enrolled: 72 infants in the intervention group and 83 in the control group. Infants in the intervention group achieved full-volume feedings sooner (7 vs 10 days, median), regained birth weight faster (11 vs 13 days, median), and had fewer days of intravenous fluids (6 vs 8 days, median). Three infants in the intervention group and 2 control infants developed NEC for an overall incidence of 3.2% (relative risk: 1.73; 95% confidence interval: 0.30–10.06).
Conclusion. Among infants between 1000 and 2000 g at birth, starting and advancing feedings at 30 mL/kg per day seems to be a safe practice and results in fewer days to reach full-volume feedings than using 20 mL/kg per day. This intervention also leads to faster weight gain and fewer days of intravenous fluids.
Comment: Currently we usually advance feedings by 20 ml/kg/day, but this demonstration that increments of 30 ml/kg/day has an acceptable safety profile should result in an immediate change in our clinical practice. Although morbidities other than NEC were not discussed in this article, one might expect to see a decreased need for peripheral and percutaneous central lines and a lower incidence of bloodstream nosocomial infections. It would not be prudent to generalize the results of this study to infants with birth weight less than 1000 grams given differences in gastrointestinal physiology and cardiovascular stability. –MLH
Date: 09 Mar 2005
Time: 23:22:10
What type of feeding was used? If Breast Milk was not available what
concentration of formula is being used?
email: jjohns35@tampabay.rr.com
Date: 11 Mar 2005
Time: 02:32:56
This the first (RCT)Prospective data to show that there is no increase in NEC in
using advancement of rapid feeding advancement. The 20 ml/kg advancement and
higher calorie feeding(>27cal/oz) are all from retrospective reviews.
UserName: Ravi Agarwal, MD
telephone: 908-531-1705
email: neodoc1@yahoo.com
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