Continuous nasogastric milk feeding versus intermittent bolus milk feeding for premature infants less than 1500 grams

There is no difference in time to achieve full feedings in low birth weight premature infants fed milk through a tube into the stomach either on a continuous basis or over 10 to 20 minutes every two to three hours. Premature infants born weighing less than 1500 grams are not able to coordinate sucking, swallowing, and breathing. Feeding into the gastrointestinal tract (enteral feeding) helps with gastrointestinal tract development and growth. Therefore, in addition to feeding through a tube into a vein (parenterally), premature infants may be fed milk through a tube placed either up their nose and into the stomach (nasogastric feeding) or through their mouth and into the stomach (orogastric feeding). Usually a set amount of milk is given over 10 to 20 minutes every two to three hours (intermittent bolus gavage feeding). Some clinicians prefer to feed premature infants continuously. Each feeding method has beneficial effects (e.g., achieve full feedings sooner) but can also have harmful effects (destructive inflammation of the gastrointestinal tract or necrotizing enterocolitis. There was no difference in time to achieve full feedings between feeding methods regardless of tube placement. Reports of the incidence of destructive inflammation of the gastrointestinal tract (necrotizing enterocolitis) were similar. However, there is not enough evidence to determine the best feeding method for low birth weight premature infants. More research is required in this area.

Authors' conclusions: 

Small sample sizes, methodologic limitations, inconsistencies in controlling variables that may affect outcomes, and conflicting results of the studies to date make it difficult to make universal recommendations regarding the best tube feeding method for premature infants less than 1500 grams. The clinical benefits and risks of continuous versus intermittent nasogastric tube milk feeding cannot be reliably discerned from the limited information available from randomised trials to date.

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Background: 

Milk feedings can be given via nasogastric tube either intermittently, typically over 10 to 20 minutes every two or three hours, or continuously, using an infusion pump. Although theoretical benefits and risks of each method have been proposed, effects on clinically important outcomes remain uncertain.

Objectives: 

To examine the evidence regarding the effectiveness of continuous versus intermittent bolus nasogastric milk feeding in premature infants less than 1500 grams.

Search strategy: 

Searches were performed of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2011), MEDLINE, CINAHL and HealthSTAR up to July 2011.

Selection criteria: 

Randomised and quasi-randomised clinical trials comparing continuous versus intermittent bolus nasogastric milk feeding in premature infants less than 1500 grams.

Data collection and analysis: 

Two review authors independently assessed all trials for relevance and methodologic quality. The standard methods of the Cochrane Neonatal Review Group were used to extract data.

Main results: 

Overall, the seven included trials, involving 511 infants, found no differences in time to achieve full enteral feeds between feeding methods (weighted mean difference (WMD) 2 days; 95% CI -0.3 to 3.9) . In the subgroup analysis of those studies comparing continuous nasogastric versus intermittent bolus nasogastric milk feedings the findings remained unchanged (WMD 2 days, 95% CI -0.4 to 4.1). There was no significant difference in somatic growth and incidence of NEC between feeding methods irrespective of tube placement. One study noted a trend toward more apneas during the study period in infants fed by the continuous tube feeding method compared to those fed by intermittent feedings delivered predominantly by orogastric tube placements [mean difference (MD) 14.0 apneas during study period; 95% CI -0.2 to 28.2]. In subgroup analysis based on weight groups, one study suggested that infants less than 1000 grams and 1000 to 1250 grams birth weight gained weight faster when fed by the continuous nasogastric tube feeding method compared to intermittent nasogastric tube feeding method (MD 2.0 g/day; 95% CI 0.5 to 3.5; MD 2.0 g/day; 95% CI 0.2 to 3.8, respectively). A trend toward earlier discharge for infants less than 1000 grams birth weight fed by the continuous tube feeding method compared to intermittent nasogastric tube feeding method (MD -11 days; 95% CI -21.8 to -0.2).

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