Advances in Neonatal and Pediatric Nutrition

Aim: To compare the effect of 3-hourly (3-h) versus 2-hourly (2-h) feeding schedules on time to reach full feeds in neonates weighing

less than 1500 grams.

Materials & Methods: This was a randomized trial conducted in a level 3 neonatal intensive care unit, Surya Children’s Hospital,

Mumbai, India. We enrolled 120 preterm neonates with birth weights of 501 to 1500 g. The neonates were divided into 2 strata

based on birth weight: 501 to 1000 g and 1001 to 1500 g. The neonates were randomized into 2 orogastric feeding schedules: 8 or 12 feeds (3-h or 2-h schedules, depending upon randomization) and a uniform feeding protocol was followed. Analysis was performed

using the intention-to-treat principle. Categorical variables were compared using the Chi-square test. Continuous measures between

groups were compared using 2-sample t test or Mann Whitney U test as appropriate. Data were analyzed using IBM SPSS version 21

software. P<0.05 was considered significant. Primary outcome measures were time (in days) to reach full feeds (defined as tolerance of 150 mL/kg/d of feeds for at least 48 h). Secondary outcome measures were time (in days) to attain birth weight; time (in days) to discharge; weight, length and head circumference at discharge; incidence of feed intolerance, Necrotizing Enterocolitis (NEC), intravascular hemorrhage (IVH), screen-positive sepsis, culture-positive sepsis, hypoglycemia, apnea, jaundice and Retinopathy of Prematurity (ROP), duration of total Parental Nutrition (TPN) and nursing and mortality.

Results: A total of 215 neonates were assessed for eligibility of which 95 were excluded. Hence, 120 neonates were enrolled in the

trial. There was no significant difference in time (in days) to reach full feeds in the 2-h versus 3-h groups (9.53±4.26 v/s 9.85±5.48;

P=0.73). There was no significant difference between the 2 groups in most of the secondary outcomes. However the total time spent

per day in feeding was significantly lesser in the 3-h feeding schedule group (P=0.04). Subgroup analysis revealed that among the

neonates in the lower birth weight strata (501 to 1000 gms), those fed 2 hourly reached full feeds earlier compared with those fed

3-hourly (2-h group: 11.24±2.88 d vs. 3-h group: 14.14±4.98 d; P=0.041).

Conclusions: There was no significant difference in time to reach full feeds in all the neonates, irrespective of whether they were fed

2-h or 3-h. However, neonates < 1000 g reached full feeds earlier when fed more frequently (2-h feeding schedule).