Implementation of Cue-Based Feeding to Improve Preterm Infant Feeding Outcomes and Promote Parents’ Involvement

ObjectiveTo implement cue-based feeding for preterm infants and to assess its effects on time to achieve full oral feedings, length of stay, and parents’ involvement in the feeding process.DesignA quality improvement project with a pre–post evidence-based practice implementation design.SettingLevel III NICU in a quaternary hospital in the U.S. Northeast.ParticipantsMedical records of preterm infants from 23 0/7 weeks to 31 6/7 weeks gestational age who were eligible for initiation of oral feeding.Intervention/MeasurementsWe implemented cue-based feeding through staff education and training. We completed a retrospective review of the medical records of 82 preterm infants before implementation and 167 preterm infants after implementation for the outcomes of time to achieve full oral feedings, length of stay, and parents’ involvement in the feeding process.ResultsFor infants 23 0/7 weeks to 27 6/7 weeks gestation, time to achieve full oral feedings decreased by 7 days, length of stay decreased by 4.4 days, and parents’ involvement in the feeding process increased by 80% from before to after implementation. For infants 28 0/7 weeks to 31 6/7 weeks, time to achieve full oral feedings decreased by 6.6 days, length of stay decreased by 2.7 days, and parents’ involvement in the feeding process increased by 49% from before to after implementation. The organization saved $103,950 per year by decreasing length of stay.ConclusionsCue-based feeding decreased time to achieve full oral feedings, decreased length of stay, increased parents’ involvement in the feeding process, and resulted in cost savings for the institution.     

Erythromycin and feeding intolerance in premature infants: a randomized trial.

OBJECTIVES: To evaluate the effectiveness of low-dose oral erythromycin to treat feeding intolerance in preterm infants. DESIGN: This study was a prospective, double-blind, randomized, placebo-controlled trial on 60 premature infants suffering from feeding intolerance. Thirty infants were given oral erythromycin 1 mg/kg every 8 h and 30 infants were given placebo (normal saline). Randomization was stratified on enrollment according to gestational age whether >32 weeks or 32 weeks, the erythromycin group achieved full enteral feeding earlier than placebo group (10.5+/-4.1 vs 16.3+/-5.7 days, respectively; P=0.01) had fewer episodes of gastric residuals (P<0.05) and shorter duration of parenteral nutrition (PN) (P<0.05). On the other hand, in infants with gestational age 32 weeks gestation. A similar effect on younger preterm infants was not demonstrable.     

Interneonatal intensive care unit variation in growth rates and feeding practices in healthy moderately premature infants.

BACKGROUND: Variation in care and outcomes of very low birth weight infants (VLBW) in neonatal intensive care units (NICU) has been widely reported in the past decade. Less is known about care provided to healthy premature infants born between 30 and 35 weeks gestational age (GA). We have previously reported inter-NICU variation in discharge (D/C) timing and achievement of maturational milestones in this population. OBJECTIVE: To compare inter-NICU growth outcomes and feeding practices in healthy, moderately premature infants. METHODS: Records of 450 infants, 30 to 35 weeks gestation, without medical or surgical complications, and consecutively discharged from 15 Massachusetts NICUs (nine Level II and six Level III) were reviewed. Final analyses included 382 infants with hospital length of stay >6 days (d). RESULTS: GA at birth and birth weight (BW) were 33.2 weeks (SD 1.2) and 2024 g (389). Mean Z-score decreased 0.67z (0.37) from birth to D/C. Weight loss from birth to 7 d averaged 4.0%. Mean growth velocity from 7 d to D/C was 13.3 g/k/d (5.2) with net growth velocity of 5.5 g/k/d (5.6). Mean net growth velocity ranged from 0.1 to 8.4 g/k/d (p<0.001) among study NICUs. Time of initiation, rate of advancement and caloric density of feedings also varied significantly between NICUs. CONCLUSION: Mean NICU growth velocity of healthy, moderately premature infants did not achieve in utero growth standards. There was significant inter-NICU variation in growth outcomes and feeding practices. Further study is needed to identify practices associated with better growth in this healthy moderately premature infant population.     

Pacing as a treatment technique for transitional sucking patterns.

OBJECTIVE: To ascertain whether the implementation of a paced feeding protocol in a sample of preterm infants with respiratory diagnoses will result in the development of more efficient sucking patterns, increased weight gain, decreased incidence of bradycardia during feeding, and shorter length of hospital stay. METHOD: A total of 36 premature infants were enrolled into a nonrandomized clinical trial conducted in a neonatal intensive care unit (NICU). The first 18 infants were traditionally bottle-fed. Following this cohort's discharge from NICU, nursing staff completed continuing education on implementing a paced feeding protocol and the next 18 infants were delivered paced feedings. RESULTS: The two cohorts were equivalent at the initiation of oral feedings on gestational age, birth weight, 1 and 5 minute Apgar scores, weight, and postconceptual age. The paced infants demonstrated statistically and clinically significant decreases in bradycardic incidences during feeding and gains in development of more efficient sucking patterns at discharge. Discharge and average weekly weight gain did not differ between the two groups. CONCLUSIONS: The incorporation of pacing into NICU care practices appears to be beneficial for preterm infants with respiratory disease.     

Demand vs. Scheduled Feedings for Premature Infants

To compare the effects of demand and schedule feeding in premature infants who weighed less than 2500 grams at birth and who were appropriate for gestational age, 36 premature infants were studied. Premature infants were assigned randomly to either demand (N = 18) or scheduled (N = 18) feedings in a regional NICU in a metropolitan hospital. Infants that were allowed to feed on demand took amounts of formula and calories similar to those infants who were fed specified amounts of formula every three or four hours. Demand-fed infants were bottle-feeding well enough to be discharged earlier than schedule-fed infants, required fewer feedings per day, and needed fewer gavage feedings. No complications related to feedings were seen in either group.     

北京地区晚期早产儿肠内营养支持现状及影响因素

目的分析北京地区不同级别医院收治胎龄34~36周+6晚期早产儿的肠内营养支持现状及相关影响因素。方法前瞻性纳入2015年10月至2017年10月间北京地区共25家医院收治的晚期早产儿,记录其营养管理及营养相关并发症的数据。分析不同胎龄、不同级别医院的晚期早产儿的纯母乳喂养情况,以及晚期早产儿达足量喂养情况及影响因素。采用t检验、Mann-Whitney U检验、方差分析、Kruskal-Wallis检验、χ^2检验等对数据进行统计学分析。多因素分析时采用二元logistic回归、Cox回归分析。结果(1)研究期间,共1463例晚期早产儿纳入,胎龄(35.6±0.8)周,范围为34.9~36.1周。34~34周+6与35~35周+6及36~36周+6晚期早产儿相比,住院时间更长[10(8~13)与8(7~10)、7(6~9)d,P值均<0.05],最低体重下降幅度更大[4.3%(2.6%~6.3%)与3.8%(2.0%~5.6%)、3.3%(1.9%~5.5%),P值均<0.05],呼吸暂停及新生儿呼吸窘迫综合征发生率更高[分别为5.3%(20/369)与2.1%(12/566)、1.3%(7/528),7.1%(28/369)与3.0%(17/566)、3.2%(17/528),P值均<0.05],出院时未恢复出生体重者比例更低[32.5%(120/369)与38.7%(219/566)、47.9%(253/528),P值均<0.05]。34~34周+6、35~35周+6及36~36周+6晚期早产儿母亲孕期并发症方面,仅胎膜早破的发生率差异有统计学意义[6.2%(23/369)与12.7%(72/566)、11.9%(63/528),χ^2=10.244,P=0.007]。(2)晚期早产儿住院期间加奶速度为13.7(10.5~17.3)ml/(kg·d),且以早产儿配方奶喂养为主(46.0%,673/1463);住院期间纯母乳喂养的比例仅为4.5%(66/1463),出院时纯母乳喂养的比例可升高到14.4%(211/1463)。25家医疗单位出院时母乳喂养的比例差异有统计学意义(χ^2=327.893,P<0.001),纯母乳喂养比例最高的单位可以达到32%,最低为0。(3)logistic回归分析显示,妊娠期糖尿病(OR=2.426,95%CI:1.075~5.473,P=0.033),胎膜早破(OR=8.726,95%CI:1.193~63.802,P=0.033)可能是晚期早产儿纯母乳喂养的独立危险因素。出院时肠内营养量达到150 ml/(kg·d)的比例为28.4%(416/1463),达到120 kcal/(kg·d)(1 kcal=4.184 kJ)的比例为19.2%(281/1463)。单因素及多因素Cox回归分析显示,医院级别(HR=1.470,95%CI:1.030~2.098)、住院时间(HR=1.162,95%CI:1.097~1.231)、出生体重(HR=0.946,95%CI:0.898~0.995)、纯母乳喂养(HR=2.354,95%CI:1.031~5.374)、喂养不耐受(HR=3.677,95%CI:1.201~11.253)、肠外营养支持(HR=1.900,95%CI:1.379~2.616)及加奶速度(HR=1.426,95%CI:1.369~1.484)是晚期早产儿出院时能否达到足量喂养的独立影响因素(P值均<0.05)。结论晚期早产儿的营养支持现状特点为纯母乳喂养率较低,各医疗单位间存在较大差异,平均加奶速度较慢,多数晚期早产儿出院时未能达到足量喂养。妊娠期糖尿病和胎膜早破是影响晚期早产儿纯母乳喂养的独立危险因素。而出生体重低、住院期间纯母乳喂养、存在过喂养不耐受、应用过肠外营养支持、住院时间较长或加奶速度更快的晚期早产儿更倾向于能够在出院前达到足量喂养。     

Relationship Between Integrated Sucking Pressures and First Bottle-Feeding Scores in Premature Infants

Reasons for delays in initiating premature infant bottle-feeding and the complications associated with various methods of providing nutrition to premature infants are discussed. A quantitative, correlational study was undertaken to assess premature infants' readiness to bottle-feed. Thirty premature infants, weighing 1,230 to 2,020 g were studied to determine the relationship between integrated sucking pressures and bottle-feeding scores. Sucking pressures were measured with research nipples and an electronic suckometer. Feeding ability was measured using a complex research scale and a simpler clinical scale. Feeding scales correlated significantly (r = 0.79, p less than 0.001) while sucking pressures and feeding scores did not correlate significantly. Study limitations may have been responsible for the lack of a significant correlation between sucking pressures and feeding scores. Further research is needed to establish simple, quantitative safety parameters for beginning oral feedings for premature infants.     

Demand feeding for healthy premature newborns: a randomized crossover study.

BACKGROUND AND PURPOSE: In hospitals, preterm infants are routinely fed specified amounts of formula on a fixed schedule. This results in the baby's intake volume being regular and easily confirmed, but does not consider the individual baby's needs. The purpose of this study was to compare the effects of demand feeding and fixed schedule feeding for healthy premature newborn babies. METHODS: A 2-feeding-type, 2-period crossover study design was employed, in which each period consisted of 2 days, the first of which was a washout period, comprising a self-comparison protocol designed to identify any differences in the feeding characteristics of premature infants on demand or scheduled bottle-feeding. Eleven preterm infants were included. The sample size was monitored during the observation period by power calculation. The mean weight at study entry was 1897.27 +/- 175.94 g and the mean postconceptional age was 35.34 +/- 1.54 weeks. RESULTS: Compared with scheduled feeding, demand feeding was associated with a longer daily mean interval (4.17 vs 3.02 hours; p = 0.00), greater volume per feed for demand feeding (67.28 vs 51.11; p = 0.00), greater feeding speed (5.73 vs 4.51 mL/min; p = 0.00), but a similar daily total duration of feeding. There was no significant difference in the daily total feeding volume. CONCLUSIONS: Demand feeding provides superior volume per feed, and feeding speed and shortens the duration of feeding compared to feeding on a routine schedule. It is suitable and feasible for healthy premature newborns.     

A prospective controlled study of neonatal morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-class Al).

OBJECTIVE: Infants of gestational diabetes mellitus (GDM)-A1 women are unlikely to experience the marked excursion in maternal glucose levels that may characterize insulin-requiring GDM (class-A2) or insulin-dependent diabetes (IDDM). However, infants born to GDM-A1 women are traditionally managed like infants born to GDM-A2 or IDDM women. AIMS: To examine monitoring protocols for infants of GDM-A1 women, and to examine the efficacy of early and frequent feedings to prevent and to treat hypoglycemia. METHODS: A total of 92 of 101 infants born to GDM-A1 women (diabetic group) and 68 of 83 infants born to nondiabetic women (control group) at > or=36 weeks of gestation were prospectively monitored for the development of hypoglycemia and other morbidities. Blood glucose screening was performed in the diabetic group every 30-60 minutes three times, starting soon after birth and then at 3-hour intervals for 24 hours. Liberal feedings were started shortly after birth and provided every 3 hours for at least 24 hours. All women with GDM-A1 had an HbA1c measured before delivery. RESULTS: Both the diabetic and control groups had similar demographics, including LGA incidence. Blood glucose readings before feedings were low (<40 mg/dl) in 24 of 92 infants (26.1%) from the diabetic group and in 20 of 68 control infants (29%). After the start of oral feedings, all but four diabetic and three control infants had subsequent glucose readings > or =40 mg/dl. No infant had symptoms of hypoglycemia and none from the diabetic group had birth trauma, hypoxic-ischemic encephalopathy, polycythemia, hypocalcemia, or hypomagnesemia. Hypoglycemic episodes in the infants from the diabetic group could be managed with oral feedings alone. Birth weight, gestational age, sex, Apgar scores, and maternal HbA1c levels could not predict low glucose readings on initial screening in infants from the diabetic group. CONCLUSION: The incidence of hypoglycemia in infants born to GDM-A1 women at > or =36 weeks of gestation is similar to control infants born to nondiabetic women. Low blood glucose levels during the first few hours of life can be prevented or treated with early and frequent oral feeding.     

早产儿喂养不耐受的临床特征及危险因素

目的探讨早产儿喂养不耐受的临床特征及危险因素。方法本研究为回顾性研究。研究对象为2017年1月至2017年12月在北京大学第三医院新生儿科住院的早产儿,进一步将其中的喂养不耐受组患儿按出生胎龄分为<31周组和≥31周组,以及按出生体重分为<1250 g组和≥1250 g组。分析纳入对象的病历资料,探讨早产儿喂养不耐受的临床特征及其危险因素。采用独立样本t检验、χ^2检验和logistic回归分析等方法,对数据进行统计学分析。结果(1)符合标准的研究对象共612例,其中喂养不耐受组182例(29.7%),喂养耐受组430例(70.3%)。喂养不耐受组中,男婴103例(56.6%),女婴79例(43.4%);胎龄(30.6±2.3)周,其中93例(51.1%)胎龄<31周;出生体重(1298±417)g,其中93例(51.1%)<1250 g;134例(73.6%)为极低出生体重儿。喂养不耐受在极低出生体重早产儿中的发生率为63.2%(134/212)。(2)喂养不耐受的诊断日龄为(2.7±0.9)d,消失日龄为(13.2±6.9)d,持续时间为(10.5±6.7)d,主要症状包括胃潴留100.0%(182/182)、腹胀54.4%(98/182)和呕吐17.0%(31/182)。(3)与胎龄≥31周者相比,胎龄<31周的早产儿喂养不耐受诊断和消失更晚[(2.4±0.8)与(2.9±0.9)d,t=3.977;(10.4±5.2)与(16.0±7.3)d,t=5.935],持续时间更长[(8.0±5.0)与(13.0±7.3)d,t=5.450],恢复出生体重时间更晚[(9.4±4.1)与(12.0±5.1)d,t=3.672](P值均<0.05)。与出生体重≥1250 g的早产儿相比,出生体重<1250 g的早产儿喂养不耐受诊断和消失更晚[(2.5±0.9)与(2.8±0.9)d,t=2.540;(10.0±4.5)与(16.3±7.4)d,t=6.951]、持续时间更长[(7.5±4.3)与(13.5±7.3)d,t=6.690]、更少发生呕吐[23.6%(21/89)与10.8%(10/93),χ^2=5.308](P值均<0.05)。(4)出生体重是早产儿喂养不耐受的保护因素(OR=0.998,95%CI:0.997~0.998),新生儿呼吸窘迫综合征(OR=2.129,95%CI:1.163~3.897)、多胎(OR=1.812,95%CI:1.116~2.941)、生后48 h内应用枸橼酸咖啡因(OR=2.663,95%CI:1.619~4.381)、生后48 h内应用持续气道正压通气(OR=5.211,95%CI:2.861~9.489)和宫内感染(OR=1.988,95%CI:1.060~3.728)是早产儿喂养不耐受的独立危险因素(P值均<0.05)。结论早产儿喂养不耐受发生率较高;胎龄较小、出生体重较低的早产儿喂养不耐受发生和消失时间较晚,持续时间较长;出生体重低、新生儿呼吸窘迫综合征、多胎、生后48 h内应用枸橼酸咖啡因、生后48 h内应用持续气道正压通气和宫内感染是早产儿喂养不耐受的危险因素。     

A National Survey of Neonatal Intensive-Care Units: Criteria Used to Determine Rediness for Oral Feedings

Objective : To describe criteria used to determine readiness for oral feedings in stable, preterm infants.
Design : A 25-item survey questionnaire was mailed to hospitals having level II or level III NICUs.
Setting : Nurseries identified in the 1987 National Perinatal Directory (576 in all) as level II or level III NICUs.
Participants : Head nurses (HN) and staff nurses (SN) at 420 hospitals comprised 73% of the sample surveyed. Procedures: Survey items were predominantly multiple choice and included an "other" option to encourage comments.
Main Outcome Measures : Respondents described clinical practice in their nurseries relative to feeding policies, use of traditional decision criteria, or behavioral cues and related interventions.
Results/Conclusions : Fewer than 50% of nurseries identified a specific feeding policy for the initiation of oral feedings. Seventy-five percent used either gestational age or weight criteria in deciding when to start oral feedings. Eighty-six percent considered infant behavior as well when determining feeding readiness. Findings suggest an emerging emphasis on infant behavioral cues in addition to gestational age and weight criteria when making feeding decisions.     

The early use of minimal enteral nutrition in extremely low birth weight newborns.

OBJECTIVE: To gather information regarding the efficacy of early minimal enteral nutrition on overall feeding tolerance in extremely low birth weight infants. STUDY DESIGN: Prospective randomized controlled trial comparing the early use of minimal enteral nutrition in extremely low birth weight infants from day 2 to day 7 vs control infants. On day 8, feeding volume in both groups were advanced by 10 ml kg(-1) day(-1) until full enteral feedings were reached. Time to full feeds, number of intolerance episodes, anthropometric measurements, peak total bilirubin levels, incidence of necrotizing enterocolitis and incidence of sepsis were compared between the two groups with t-test and chi (2) test. RESULT: Eighty-four infants were enrolled in the study but only 61 infants completed the feeding protocol. No statistically significant differences were found between the groups with regards to growth patterns, feeding tolerance, mortality, length of hospital stay and incidence of sepsis and necrotizing enterocolitis. CONCLUSION: Early minimal enteral nutrition use in extremely low birth weight infants did not improve feeding tolerance.     

Gallbladder distention in premature neonates receiving parenteral nutrition

Contraction of the gallbladder is mediated through the release of cholecystokinin from duodenal cells secondary to enteral feedings. Premature infants are often nourished by parenteral hyperalimentation leading to prolonged inactivation of the gallbladder. Such inactivation probably accounts for the increased incidence of gallbladder distention observed in premature neonates. Two cases of premature infants are described in whom distention of the gallbladder occurred during parenteral hyperalimentation. The distention resolved spontaneously secondary to the introduction of enteral feedings. A trial period of oral or tube feeding is recommended in such cases prior to any attempt to release the distention by a surgical intervention.     

A pioneering study: oral clarithromycin treatment for feeding intolerance in very low birth weight preterm infants

Purpose: To examine the prokinetic effect of clarithromycin in very low birth weight (VLBW) preterm infants.

Materials and methods: VLBW preterm infants who have not achieved half of the full enteral feeding in the second week of life were enrolled in the study. The infants enrolled in the study were randomized. Twenty infants received oral clarithromycin (7.5?mg/kg, twice a day) and 20 control infants did not receive any treatment.

Results: Full enteral feeding was attained earlier in the clarithromycin group than in the control group [7 (6–9) versus 9 (9–11) days, respectively; p?p?=?.013 and p?n?=?1 versus 3, p?=?.1) and length of hospital stay (50 versus 59 median days, p?=?.1) tend to be lower in the clarithromycin group without any statistical significance. We observed no adverse effect of clarithromycin therapy.

Conclusions: Clarithromycin treatment in VLBW preterm infants resulted in better toleration of enteral feeding. Larger randomized controlled trials are needed to establish routine use of clarithromycin in the treatment of feeding intolerance.     

A comparison of the safety of cupfeedings and bottlefeedings in premature infants whose mothers intend to breastfeed.

OBJECTIVE: To compare the safety of cupfeeding, an alternative feeding method, to bottlefeeding, the current standard of artificial feeding in the United States, in preterm infants whose mothers intend to breastfeed. STUDY DESIGN: In a prospective, randomized crossover study, 56 infants or=34 weeks' corrected gestational age, the order of the first two non-breast oral feedings was randomized by coin toss to one cupfeeding and one bottlefeeding. Trained Neonatal Intensive Care Unit nurses provided the feedings. Heart rate, respiratory rate, and oxygen saturation were recorded at 1-minute intervals for 10 minutes before and during the feeding. Volume taken, time required to complete the feed, and any apnea, bradycardia, choking, or spitting episodes were recorded. RESULTS: Heart rate (p<0.0001) and respiratory rate (p<0.0001) increased and oxygen saturation decreased (p=0.0002) during both cup and bottlefeedings compared to pre-feeding baselines. The amount of change in these three parameters from baseline to feeding period was similar for both feeding methods. The fraction of O(2) saturation <90% during baseline compared to the study period was different between these two feeding methods (p=0.02). There was a 10-fold increase in desaturations <90% during bottlefeeds compared to no change during cupfeeds. When comparing cupfeeding periods to bottlefeeding periods, heart rates were higher (p=0.009) and oxygen saturations lower (p=0.02) during bottlefeeds. There were no differences between methods in respiratory rate, choking, spitting or apnea, and bradycardia. Volumes taken were lower (p=0.001) and duration of feeds longer (p=0.002) during cupfeedings. CONCLUSION: During cupfeedings, premature infants are more physiologically stable, with lower heart rates, higher oxygen saturations, and less desaturations, than during bottlefeedings. However, cupfed infants took less volume, over more time, than bottlefed for these initial feedings. Based on better physiologic stability and no difference in untoward effects, cupfeeding is at least as safe, if not safer, than bottlefeeding in this population. This study supports the use of cupfeeding as a safe alternative feeding method for premature infants learning to breastfeed.     

Clarithromycin treatment in preterm infants: a pilot study for prevention of feeding intolerance

Abstract

Objective: To compare the effectiveness of oral clarithromycin versus placebo treatment in preventing feeding intolerance in very low birth weight (VLBW) infants.

Study Design: A prospective, randomised controlled trial in which two groups of preterm infants (birth weight <1500?g) were randomised to clarithromycin (7.5?mg/kg/dose every 12?h) or placebo treatment. During the period, 38 infants, whose parents accepted participation, were enrolled in the study. Feeding intolerance and time to achieve full enteral feeding were considered as primary outcome measures.

Results: Feeding intolerance was significantly longer in placebo than clarithromycin (p?=?0.031). Time to achieve full feeding after beginning the treatment was equal among the groups.

Conclusion: This is the first randomised controlled study of clarithromycin and placebo treatment that compares the improvement of feeding intolerance in VLBW infants. Our findings indicate a dramatic improvement in feeding intolerance after oral clarithromycin treatment. But according to our results, clarithromycin-treated infants were not able to attain full enteral feeding more quickly than placebo. This may be due to prophylactic usage of clarithromycin. Significant differences might have resulted if only infants who had feeding intolerance were recruited.     

Early enteral fat supplementation with microlipid® and fish oil in the treatment of two premature infants with short bowel

The infusion of Intralipid? is a main risk factor for parenteral nutrition-associated cholestasis in infants with short bowel syndrome. Early provision of enteral fat to reduce the use of Intralipid while providing adequate fat for the growth of infants with short bowel has not been reported. We present 2 cases of premature infants with short bowel who received early supplementation of enteral Microlipid? and fish oil. This approach allowed us to discontinue Intralipid shortly after initiating feedings. The infants tolerated Microlipid/fish oil well without adverse reactions, had appropriate weight gain and ostomy output. They underwent bowel reanastomosis 3 weeks after enteral feeding began, and were discharged on full oral feedings. In case 1, the infant did not develop parenteral nutrition-associated cholestasis; in case 2, cholestasis had developed before initiating feeds, but was not aggravated by enteral fat and was improving prior to discharge.     

Cup or bottle for preterm infants: effects on oxygen saturation, weight gain, and breastfeeding.

The impact of cup-feeding or bottle-feeding on weight gain, oxygen saturation, and breastfeeding rates of preterm infants was studied in 34 bottle-fed and 44 cup-fed preterm infants. At initiation of oral feeding, postconceptional age and weight were 37.2 +/- 2.2 weeks and 1676 +/- 83 g for the bottle-fed group (BF) and 37.0 +/- 1.6 weeks and 1637 +/- 40 g for the cup-fed (CF) group, respectively. No significant differences between groups were found with regard to time spent feeding, feeding problems, weight gain, or breastfeeding prevalence at discharge or at 3-month follow-up. Possible beneficial effects of cup-feeding were lower incidence of desaturation episodes (13.6% vs 35.3%, CF vs BF, P = .024) and a higher prevalence of breastfeeding at 3 months among those still breastfeeding at the first follow-up visit (68.4% vs 33.3%, CF vs BF, P = .04).     

Cue-based feeding for preterm infants: a prospective trial

We set out to test whether premature infants were able to be fed orally on feeding cues and be discharged home earlier than infants fed by traditional feeding regimens. Attainment of adequate growth, adverse events, and nursing time to provide care were also assessed. After screening, the recruited premature infants (< 36 wks post-conceptual age [PCA]) were divided into two feeding regimens. A control group of 40 infants was fed using an initial combination of scheduled gavage and bottle feeding and then graduating to demand feeds. The intervention group comprised 39 neonates who had gavage feeds discontinued at study entrance and fed orally on cues. Outcomes measured were: weight gain in grams/kg/day, length of stay (in days) after enrollment, PCA on entrance and at discharge, adverse events during feeding, number of cues per feed in the intervention group, and resource utilization using nurse/patient ratios. Differences between groups were evaluated using Mann-Whitney U test, Fisher's exact test, and regression analysis. Two-tailed P values of < 0.05 were considered significant. There was no difference between groups in the mean weight gain; in the control group mean weight gain was 12.5 gm/kg/day and in the intervention group 12.1 gm/kg/day ( P = 0.83). The average length of stay in the control group of 14.5 days was significantly longer than the 10.0 days in the intervention group ( P = 0.009). This difference remained significant after adjusting for gestational age at birth in regression analysis. The average total number of adverse events in the control group (12.5 events) was significantly greater than in the intervention group (3.5 events; P = 0.007). The mean PCA on study entry was 34.4 wks in both groups and on exit 36.5 wks in the control group and 35.8 wks in the intervention group, a significant difference ( P = 0.02), The intervention group elicited 2.8 cues/feed. The nurse to patient ratios was equal in both groups throughout the study period. Cue-based feeding was possible for premature infants with similar weight gain as traditional feeding without affecting workload. Hospitalization and adverse events were decreased.     

口服红霉素防治早产儿喂养不耐受的meta分析

目的 系统评价口服红霉素防治早产儿喂养不耐受的疗效和安全性.方法 检索Cochrane图书馆、PubMed、EMBASE、中国生物医学文献光盘数据库、中国期刊全文数据库、中国维普数据库和万方全文数据库等刊载的红霉素防治早产儿喂养不耐受的随机对照试验(randomized controlled trial,RCT)文献.按Cochrane系统评价方法进行文献质量评价,采用RevMan软件进行meta分析.对口服红霉索不同剂量(每日3～15 mg/kg为小剂量,>15 mg/kg为大剂量)及纳入对象胎龄(≤32周或>32周)行亚组分析,以评价其在防治早产儿喂养不耐受中的作用.结果 共纳入9个RCT,包括542例早产儿.因部分研究指标存在差异,未能全部行合并分析.(1)预防性研究:对出生胎龄≤32周的早产儿,小剂量较大剂量红霉素口服能缩短达到全肠内喂养及静脉营养时间(WMD=-2.99,95%CI:-3.99～-1.98).(2)治疗性研究:胎龄≤32周时,大剂量红霉素较安慰剂能缩短达到全肠内喂养及静脉营养时间(WMD=-7.06,95%CI:-7.91～-6.20,P<0.01);能缩短住院时间(WMD=-8.10,95%CI:-14.02～-2.18,P=0.007);胎龄>32周时,大剂量红霉素能缩短全肠外营养时间(WMD=-3.90,95%CI:-7.20～-0.60,P<0.05);与对照组相比,红霉素可以降低黄疸发生率(RR=0.36,95%CI:0.21～0.63,P=0.0003),依据剂量大小行亚组分析提示仅大剂量红霉素能减少黄疽的发生.结论 对胎龄≤32周的早产儿,预防性使用小剂量红霉素能缩短达全肠内喂养及静脉营养的时间.而在治疗时,大剂量红霉素能加快达全肠内喂养时间,缩短住院及静脉营养时间,而且还能减少胆汁淤积相关性黄疸的发生.