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Earlier achievement of full enteral feeding in extremely low birth weight neonates is not associated with growth improvement in the first 2 years of life

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Abstract

Limiting the number of days until achievement of full enteral feeding in extremely low birth weight neonates (ELBW; < 1000 g) might affect growth in the first years of life. This study compared the Z scores in growth over time of two cohorts of ELBW neonates that were comparable on maternal and neonatal characteristics and characteristics of hospitalization, but differed in enteral feeding strategy during neonatal admission. In the 2010–2014 cohort, full enteral feeding was achieved on average 16 days earlier than in the 2000–2005 cohort. In both cohorts, weight, height, and head circumference were recorded at birth and at the corrected ages of 9 and 24 months. A linear mixed model with repeated measures controlling for neonates small for gestational age showed no significant effect of different strategies in achievement of full enteral feeding on any anthropometric Z scores over time. Although full enteral feeding was achieved earlier in the 2010–2014 cohort, this was not associated with growth patterns during the first two years of life.

Conclusion: The effect of a change in strategy to achieve full enteral feeding at an earlier stage in ELBW neonates was assessed. Early enteral feeding strategies do not necessarily improve growth during the first two years of life.

What is Known:

• Feeding strategies during neonatal stay may affect growth in the first years of life.

• Strategies to achieve full enteral feeding earlier were implemented, but data on the impact on subsequent growth after discharge are limited.

What is New:

• Full enteral feeding was achieved earlier, but this was not associated with improved growth during the first 2 years of life after discharge.

• Early enteral feeding strategies do not necessarily improve growth during the first 2 years of life.

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Notes

  1. The Z score for head circumference on 24 months is lower for the included cases in cohort 2010–2014 (mean ± SD, − 0.97 ± 1.24 vs. − 2.33 ± 1.57, P = 0.034). However, only four of the non-included cases had valid measurements.

Abbreviations

BPD:

Broncho-pulmonary dysplasia

ELBW:

Extremely low birth weight

GA:

Gestational age

ICH:

Intra-cerebral hemorrhage

LMM:

Linear mixed model

NEC:

Necrotizing enterocolitis

PREMATCH:

PREMATuritiy as predictor of Children’s cardiovascular and renal Health

PPROM:

Premature preterm rupture of membranes

ROP:

Retinopathy of prematurity

SD(S):

Standard deviation (score)

SGA:

Small for gestational age

SIFT:

Speed of increasing milk feeds trial

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Funding

This study was supported by the “Agency for Innovation, Science, and Technology in Flanders (IWT) through the “SAFEPEDRUG” project (IWT/SBO 120033).

Author information

Authors and Affiliations

  1. Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium

    Carolien Brants, Karel Allegaert & Anke Raaijmakers

  2. Social Policy Research Centre, University of New South Wales, Sydney, Australia

    Theun Pieter van Tienoven

  3. Department of Pediatrics and Neonatology, University Hospitals Leuven, Leuven, Belgium

    Maissa Rayyan & Anke Raaijmakers

  4. Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands

    Karel Allegaert

  5. Intensive Care and Department of Pediatric Surgery, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands

    Karel Allegaert

Authors
  1. Carolien Brants
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  2. Theun Pieter van Tienoven
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  3. Maissa Rayyan
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  4. Karel Allegaert
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  5. Anke Raaijmakers
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Contributions

K.A. and A.R. designed the study. C.B. and A.R. collected data. T.P.v.T. analysed the data, C.B.,T.P.v.T, and A.R. interpreted the data and drafted the article. M.R. and K.A. provided critical revision or the paper. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Anke Raaijmakers.

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Conflicts of interest

The authors declare that there are no conflicts of interest.

Ethical approval/informed consent

The study was conducted in accordance with the Helsinki declaration for investigations in human subjects. The local Ethics Committee of the University Hospitals Leuven (Belgium) approved the study protocol. Parents gave informed consent prior to the PREMATCH studies.

Additional information

Communicated by Mario Bianchetti

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Brants, C., van Tienoven, T.P., Rayyan, M. et al. Earlier achievement of full enteral feeding in extremely low birth weight neonates is not associated with growth improvement in the first 2 years of life. Eur J Pediatr 177, 1247–1254 (2018). https://doi.org/10.1007/s00431-018-3178-y

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  • DOI: https://doi.org/10.1007/s00431-018-3178-y

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