674 - Rapid versus Slow Advancement of Enteral Feeds in Preterm Neonates with Antenatal Absent End-Diastolic Flow: A Randomized Controlled Trial

Publication Number: 1651.674

Sushma Nangia, Lady Hardinge Medical College & Kalawati Saran Children's Hospital, New Delhi, Delhi, India; Rajesh Kumar, Lady Hardinge MEdical College, New Delhi, Delhi, India; TAPAS BANDYOPADHYAY, VMMC and Safdarjung Hospital, New Delhi, Delhi, India; Pratima Anand, Lady Hardinge Medical College, new delhi, Delhi, India

Background: Absent end-diastolic flow (AEDF) in the umbilical artery may be associated with increased risk of feeding intolerance and necrotizing enterocolitis (NEC) in preterm neonates. However optimal rate of enteral feed advancement remains unclear.

Objective: To compare the time to achieve full enteral feeds in preterm neonates (28–34+6 weeks gestation) with antenatal AEDF, randomized to rapid versus slow enteral feed advancement.

Design/Methods: In this open-label randomized controlled trial conducted at a tertiary neonatal unit, 71 eligible neonates were randomized at 6 hours of life into two groups: rapid (30 ml/kg/day) or slow (20 ml/kg/day) feed advancement. The primary outcome was time to reach full enteral feeds (150 ml/kg/day). Secondary outcomes included incidence of feed intolerance, Necrotizing enterocolitis (NEC), sepsis, duration of intravenous alimentation, hospital stay, and prematurity-related complications.

Results: Median time to full feeds was significantly shorter in the rapid group [6 days (IQR 6–10)] compared to the slow group [7 days (IQR 7–10), p< 0.001]. Incidence of feed intolerance (31.4% vs 34.3%), NEC (0%), and clinical sepsis (28.6% vs 47.2%) were not significantly different. However, late-onset sepsis was significantly lower in the rapid group (5.7% vs 31.4%, p=0.012). No neonates in the rapid group died, compared to three deaths in the slow group.

Conclusion(s): Rapid advancement of enteral feeds in neonates with antenatal AEDF was associated with earlier attainment of full feeds without increasing the risk of feed intolerance, NEC, or sepsis.