None listed
Conditions
Brief summary
Preterm delivery rates vary from 6% to 15% of all deliveries, with the rate increasing in recent years (Slattery and Morrison, 2002). In Malaysia 2006, about 3,153 were preterm babies below 32 weeks gestational age (GA) and 3,586 babies had birth weights of below 1501 (Irene Cheah, 2008) As more immature preterm infants survive, provision of enteral feedings has become a major focus of concern. Feeding problems in preterm infant are varies from very mild form such as feeding intolerance to the most fatal one such as NEC with perforated gut. For the past, enteral fasting was once used in VLBW as fear of NEC. However, currently early initiation of trophic feedings is recommended. (Sarah Bombell, William McGuire, 2009). Tube feeding is necessary for most premature infants less than 1500 grams because of their inability to coordinate sucking, swallowing, and breathing (Schanler 1999) and the danger of aspiration (Valman 1972). Many studies had done for continuous versus bolus feeding in premature infant in the past. However, a Cochrane review has shown that small babies less than 1500 grams, fed by intermittent bolus compared with continuous infusion, took a shorter time to reach full feeds with no difference in somatic growth, days to discharge, or the incidence of necrotizing enterocolitis (Premji 2002). As per conversation survey in October 2009, most of the NICU in Malaysia practice 3 hourly feeding regimes for those more then 1.5kg and 2 hourly feeding regimes for babies less then 1.5kg. However there was no organized randomized control trial to support this. In this study, we would like to test the hypothesis that extreme low birth weight infants able to tolerate 3 hourly feeding safely. By knowing that, we could establish a better feeding protocol and without compromised the infant’s health. Hopefully,the infants will receive better care if 3 hourly feeding is safe for them as nurses will have more time on other important nursing care. The infants also will have less disturbance if 3 hourly feeding can be adopted. It may also reduce the errors in preparation (50% less workload for nurses with regards to feeds) and fewer chances for contamination. Larger amount of feeding may cause some abdominal distension or probably may increase possibility of reflux thus we would like to look at it as the outcomes.
Interventions
Premature infants will be given 3 hourly feeding
1. All infants will be given IV dextrose 10% or TPN at 65 to 80mls per kg per day at the first hour of life
2. Enteral feeding will be started before 96 hours of life
3. All infants will be fed with expressed breast milk
4. If mother's breast milk is insufficient preterm formula is added
5. Feeding will be started at 10 to 20mls pe r kg per day
6. Advancement of the feeding at 10 to 20mls per kg per day 7. All the infants will be fed via oral ga
Premature infants will be given 3 hourly feeding 1. All infants will be given IV dextrose 10% or TPN at 65 to 80mls per kg per day at the first hour of life 2. Enteral feeding will be started before 96 hours of life 3. All infants will be fed with expressed breast milk 4. If mother's breast milk is insufficient preterm formula is added 5. Feeding will be started at 10 to 20mls pe r kg per day 6. Advancement of the feeding at 10 to 20mls per kg per day 7. All the infants will be fed via oral gastric tube 8. Oral gastric tube placement by staff nurse using pre established technique 9. Feeding will be given over 15 to 30 minutes with gravity depending on the volume of the milk 10. Gastric residual will be checked immediately before feeding unless requested by the managing team of not doing so. 11. If any clinical signs of enteral intolerance and/or severe medical instability were noted, then the feeding volume will be reduced or the feedings will temporarily withheld according to clinical routines. 12. TPN will be started at least before 24 hours of life, the volume is increase 15mls/kg/day to a target volume of 140 to 160 ml/kg/day 13. When enteral feedings reached 100mls/kg of the total target volume, TPN will be discontinued. 14. Pre feeding dextrostic will be monitore d every shift (8 hourly) for 48hour to observe episode of hypoglycaemia in the infants 15. Urine ketone also will be monitored every day for 48 hour once the IVD is off.
Sponsors
Short Term Grant, School Of Medical Sciences, Universiti Sains Malaysia
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
0 to 96 Hours
Healthy volunteers
No
Inclusion criteria
Premature infants of 34 weeks gestation and below The birth weight of 1000gram to 1800gram
Exclusion criteria
1. Congenital Major Malformation include chromosomal abnormalities 2. Severe asphyxia 3. Congenital GIT abnormality such as esophageal atresia, TOF
Outcome results
None listed