422 - Continuous vs. Bolus Gastric Tube Feeding in Very-Low-Birth-Weight Infants Supported with Noninvasive Respiratory Support: A Randomized, Pilot study.

Poster Number: 422
Publication Number: 422.223

Liron Borenstein-Levin, Rambam Medical Center, Haifa, HaZafon, Israel; Arieh Riskin, Rappaort Faculty of Medicine Technion Israel Institute of Technology Haifa Israel, Haifa, Hefa, Israel; Ori Hochwald, Rambam Medical Center, Haifa, Israel, Haifa, Hefa, Israel; Fanny Timstut, Rambam health care campus, Haifa, Hefa, Israel; Sonya Sendler, rambam Medical Center, Haifa, Hefa, Israel; irit shoris, Bnai zion medical center, Haifa, Hefa, Israel; Yoav Littner, RAMBAM MEDICAL CENTER, HAIFA, Hefa, Israel; Gil Dinur, Rambam Medical Center, Haifa, Hefa, Israel; Amir M. Kugelman, Rambam Medical Center, Haifa, Haifa, Tel Aviv, Israel

Background: Among infants supported with noninvasive ventilation (NIV), length of feeding is of significance as bolus feeding (BF) allows time for gastric decompression between feeds, but may increase gastrointestinal reflux while continuous gastric feeding (CGF) may hinder proper gastric decompression and lead to abdominal distention that might compromise ventilation.

Objective: To compare the time to full feeding (TFF), between CGF and BF in VLBW infants supported with NIV.
 

Design/Methods: A randomized controlled, prospective, pilot study. VLBW premature infants, supported with NIV were randomized while still on trophic feeding < 20 ml/kg/day to receive their feeding over 2 hours-CGF or over 15-30 min-BF. The primary outcome was TFF. In the BF group, in case of recurrent vomiting/regurgitation, feeding time was increased by 30 minutes and if no improvement, feeding time was changed to two hours. In the CGF group in case of increase gaseous abdominal distention, feeding time was shortened by 30 min, and if no improvement, feeding time was further shortened to 15-30 min. Analysis was done by intention to treat.

Results: Overall, 32 infants were included in this analysis, 17 in the CGF group and 15 in the BF group. Table 1 summarizes the main results. Infants in the CGF group were significantly younger and smaller than the BF group. TFF was comparable for the two groups- median(IQR) 10.0(10.0,19.0) days in the BF group vs. 12.0(9.0,13.0) days in the CGF group, p=0.59. When correcting for GA, with multivariate analysis, mode of feeding was not found to significantly affect TFF. Groups were comparable in weight gain, gastrointestinal complications, length of NIV, bronchopulmonary dysplasia incidence and post-menstrual age at discharge. Most infants from both groups (60% of BF and 70% of CGF) required changes in feeding length. Number of feeding interruptions (discontinuation of feeding for more than 2 consecutive feeds) and feeding length changes were similar between groups. Two infants from the BF group switched allocation to CGF while no infant moved from the CGF to the BF group.Conclusion(s): In this pilot study, among VLBW infants supported with NIV, TFF was comparable between the BF group and the CGF group. These results should be interpreted with caution due to the small sample size and despite the multivariate analysis correcting for the differences in GA between the groups. Interestingly, most infants required changes in feeding length regardless of their allocation. Further larger studies are needed to ascertain the preferred feeding mode during NIV in VLBW infants.
Table 1: Resultsa-Mann-Whitney rank-sum test, b-t-test, c-chi-square test.
*Feeding interruption defined as discontinuation of feeding for more than 2 consecutive feeds.
BPD- Bronchopulmonary dysplasia, PDA- Patent ductus arteriosus, IVH- Intraventricular hemorrhage, NEC-Necrotising enterocolitis, NIV-non-invasive ventilation, PMA-Postmenstrual age, SIP- Spontaneous intestinal perforation.