229 - The Association Between Slow and Fast Feed Advancement and Infant Outcomes in Cambodia: A Retrospective Observational Study

Publication Number: 1218.229

Dwita Nitoya Esterini, Brigham and Women's Hospital, Cambridge, MA, United States; Faven Russom, Boston Children's Hospital, Boston, MA, United States; luch Sreyleak, Chenla Children Healthcare, Kratie, Kratie, Cambodia; Ly Sollihak, No, Phnom Penh, Kratie, Cambodia; William Housworth, Chenla Childrens Healthcare, Louisville, KY, United States; Lori W. Housworth, Chenla Children's Healthcare, Louisville, KY, United States; Tina M. Slusher, University of Minnesota, Minneapolis, MN, United States; Lisa Gerolamo, Boston Children's Hospital, Salem, MA, United States; Deborah ODowd, Boston Children's Hospital, Maynard, MA, United States; Eastin A. Lowther, boston university, Peabody, MA, United States; Krysten North, Brigham and Women's Hospital, Boston, MA, United States

Background: More than one million infants die each year from complications of prematurity, such as sepsis, necrotizing enterocolitis, and growth failure. Information on typical feeding practices and growth patterns of preterm infants in low- and middle-income countries is limited.

Objective: Our objectives: (1) To compare feeding and growth outcomes of preterm infants who are fed with fast ( < 8 days) versus slow (>8 days) feeding advancement rates to reach full enteral feeds; (2) To examine the association between rate advancement with feeding and growth outcomes.

Design/Methods: We conducted chart reviews among a cohort of preterm infants ( < 37 weeks of gestational age/GA) at birth or low-birthweight (LBW) infants ( < 2000g) admitted to the neonatal intensive care unit (NICU) at Kratie Hospital in Cambodia (IRB: 2025P000782). The charts encompassed data from January 2023 to December 2024. To describe feeding and growth outcomes, we conducted descriptive analyses and performed Chi-square and Student's t-tests. To examine the association between feeding advancement rate and outcomes, we conducted multivariate linear and logistic regression analyses, adjusting for birth weight and acuity (days on CPAP or mechanical ventilation).

Results: We included 94 preterm infants (median gestational age [GA] 32 weeks, IQR: 30-34; median birthweight 1650 g, IQR: 1450-1900). Of these, 82 achieved full enteral feeding, with a median time of 9.5 days (IQR: 6-14). Only 56% (46/82) regained birthweight during hospitalization, including 10 in the slow-feeding group and 36 in the fast-feeding group. After adjusting for birth weight and acuity, infants in the slow-feeding group took longer to regain birth weight (β = 7.6, 95% CI: 3.6, 11.7). They also had a longer duration of IV fluids (β = 4.4 days, 95% CI: 2.2, 6.7), a longer length of stay (β = 7.5, 95% CI: 4.1, 10.8), and a higher risk of feeding intolerance (adjusted OR = 26.85, 95% CI: 5.17, 139.57). While unadjusted analyses suggested associations between feeding rates with percentage of weight loss and duration of NPO, these associations were no longer significant after adjustment.

Conclusion(s): Slow feeding in this cohort of preterm and low-birth-weight infants was associated with delayed weight attainment, longer hospital stays, and increased feeding intolerance, underscoring the need for optimized early feeding strategies.

Table 1. Infant characteristics in a cohort of preterm and low birthweight infants who reached full enteral feeds while hospitalized. Values are presented as either median (IQR) or n (%).
* Significant results

Table 2. Outcomes of interest in a cohort of preterm and low birthweight infants who reached full enteral feeds while hospitalized. Values are presented as either median (IQR), mean+SD, or n (%).
* Significant results
§ Mean days to regain birth weight for 46 infants who regained birth weight during hospitalization
✝ Growth velocity was calculated from the time of admission to discharge. Negative values were observed among babies who had not regained their admission weight at discharge.

Table 3. Associations between slow and fast rates of feeding advancement with feeding and growth outcomes.
Model 0 (M0) is unadjusted, Model 1 (M1) is adjusted with birth weight and acuity (days on mechanical ventilation or CPAP). Fast rate feeding is <8 days to full enteral feeds, and slow rate feeding is > 8 days to full enteral feeds.