167 - Feasibility and Application of Early Enteral Feeding Initiation in Extremely Low Birth Weight Infants

Poster Number: 167
Publication Number: 167.233

Lauren Ridgway, University of Nebraska Medical University (UNMC) - Omaha, NE, Omaha, NE, United States; Melissa Thoene, University of Nebraska College of Medicine, Omaha, NE, United States; Ann L. Anderson Berry, University of Nebraska Medical Center, OMAHA, NE, United States

Background: Extremely low birth weight (ELBW) infants ( < 1000 grams) have specialized nutritional needs to promote best outcomes, so identifying optimal nutrition therapies is critical. Previous studies indicate that late initiation of enteral feeds ( >3 days) is associated with increased inflammation and adverse neonatal outcomes. Likewise, delayed breastfeeding after the first hour of life in term infants has also been associated with increased mortality. In consideration of these factors and the heterogeneity that exists between enteral feeding initiation in an ELBW population, there is currently a lack of studies examining the hour of life in which enteral feeds are initiated in the ELBW infant population.

Objective: To evaluate the feasibility of early initiation of enteral feeds in ELBW infants and describe the impact on time to reach full enteral feeds.

Design/Methods: A retrospective chart review was conducted including ELBW infants born from June 2016 to July 2019 in a level III neonatal intensive care unit. Infants with congenital or genetic anomalies or who transferred or deceased prior to 30 days of life were excluded. Timing of enteral feeding initiation was analyzed using both continuous and categorical data. Feeding categories were defined as early ( < 12 hours of life), moderate (12-24 hours), or late ( >24 hours). The number of days to reach full enteral feeds was also analyzed, as defined by receiving a volume > 145 mL/kg/day of maternal or donor human milk 24 kcal/oz feedings using human milk fortifier and a protein modular.

Results: 44 ELBW infants were included. The median time of enteral feeding initiation was 12.4 hours of life (min 4.1 hours, max 178.4 hours). Enteral feeds were started in the early category for 19 infants (43%), moderate for 19 infants (43%), and late for 6 infants (14%). The median time to reach full enteral feeds was 9.5 days of life within the entire cohort. The median time to reach full enteral feeds was 9 days for infants in the early category, 10 days for moderate, and 14 days for the late feeding category.Conclusion(s): These results indicate the feasibility of initiating enteral feeds within the first 12 hours of life in the ELBW infant population. Earlier start of enteral feedings—even by hours of life—result in a reduction in the number of days to reach full enteral feeds. These results may be considered in the development of feeding protocols and early enteral nutrition initiation in the ELBW infant population. More studies are needed to assess the impact of early initiation of enteral feeds on neonatal outcomes like growth and morbidities.
Lauren Ridgway CV PAS.pdf