ENTERAL FEEDING METHODS OF NEWBORNS

ENTERAL FEEDING METHODS OF THE NEWBORNS
Premature infants in the NICU usually are fed by OG or NG tube until they are sufficiently mature to coordinate sucking, swallowing, and breathing. Then, the transition is made gradually to feeding by mouth (PO) at the breast or bottle. Staff at many NICUs encourage nonnutritive sucking, which may facilitate the tube-to-oral (bottle/breast) feeding transition.
• Initiation and advancement of feedings: Variation between NICUs and, sometimes, between neonatologists at a single unit is marked regarding when feedings are commonly initiated. Currently, some evidence exists that trophic or minimal enteral feedings are safe and well tolerated. In this technique, small volumes are fed to infants for a few days without significant increments. Many neonatologists start feedings within the first week of life and advance the feedings at a rate dependent on gestational age, degree of illness, and other clinical factors. Although some retrospective studies suggested that a rapid increase in feedings may predispose infants to necrotizing enterocolitis, prospective studies have not confirmed this. In general, most neonatologists advance feedings over a period ranging from 5-15 days in ELBW infants and over 4-10 days in neonates weighing 1000-1500 g.

• OG feedings: Conventionally, infants receive intermittent bolus gavage feedings over 10-20 minutes (by gravity) every 2-3 hours. Feedings also may be administered continuously using an infusion pump. Currently, no evidence strongly indicates that one method of feeding is superior to the other.

• Transpyloric feedings: These feedings initially were believed to reduce the risk of gastroesophageal reflux. However, studies have shown a high rate of complications using the transpyloric route, with no additional benefits; hence, it is not often used unless feeding intolerance using NG or OG tubes is marked (Macdonald, 1992).

• Fortification: Infants on breast milk commonly are fed fortified breast milk, which increases energy and mineral intake. That infants fed fortified breast milk have improved short-term
growth and bone mineral content has been documented; however, evidence of long-term benefit is insufficient. At present, whether breast milk feeding (with or without fortification) improves long-term neurodevelopment compared to preterm formula is controversial.

• Supplementation: Supplementation with long-chain polyunsaturated fatty acids (LCPUFAs), such as docosahexaenoic acid (DHA) and arachidonic acid (AA), has been recommended for preterm infants on physiologic grounds. Although visual maturation may possibly be somewhat accelerated, no long-term benefits have been demonstrated yet.

• Feedings at discharge: At discharge, premature infants usually are fed either breast milk or formula (22 cal/oz or 20 cal/oz). Some evidence exists that 22-cal/oz formula may lead to slightly better nutritional outcomes, probably because of its higher energy, calcium, and phosphate content.