Does continuous or intermittent bolus intragastric tube feeding reduce reflux of milk into the oesophagus?
Preterm and low birth weight infants are often unable to be fed orally because they cannot suck and swallow effectively. They may need to be fed via a tube placed into the stomach (intragastric). Tube feeding can be given by the intermittent bolus method, whereby milk is given over a short time (15 to 30 minutes), or by the continuous feeding method, by which milk is given over several hours. It is unclear which method is better for reducing reflux of milk into the oesophagus.
The search is up-to-date as of July 2020. We identified no studies.
We did not identify any studies that could be included in this review. Studies are needed to evaluate which method of intragastric feeding is more effective for reducing gastro-oesophageal reflux in preterm and low birth weight infants
Certainty of evidence
We found no randomised controlled trials and therefore recommend that well-designed randomised trials be conducted to conclusively prove which method is more appropriate.
We did not identify any randomised trials that evaluated the effects of continuous versus intermittent bolus intragastric tube feeding on gastro-oesophageal reflux disease in preterm and low birth weight infants. Well-designed and adequately powered trials are needed.
Gastro-oesophageal reflux disease is a particularly common condition among preterm and low birth weight infants. These infants are more likely to have excessive regurgitation, as they do not have a fully developed antireflux mechanism. Preterm and low birth weight infants who are unable to suck oral feeds are required to be fed via an intragastric tube for varying lengths of time. Intragastric tube feeding can be delivered by the intermittent bolus method or by the continuous feeding method. Use of continuous or intermittent bolus intragastric feeding may have a positive or negative effect on the incidence or severity of gastro-oesophageal reflux disease.
• To determine whether continuous or intermittent bolus intragastric tube feeding reduces the number of episodes and the duration of gastro-oesophageal reflux disease (GORD) in preterm and low birth weight infants
• To perform subgroup analyses for gestational age; birth weight; age in days from birth at full enteral feeding via intragastric tube (breast versus bottle); frequency of intermittent bolus feed; and type of medication for treatment of GORD (only if medication was prescribed and was given similarly to both intervention groups)
We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 7), in the Cochrane Library; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions(R); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), on 8 July 2020. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-RCTs.
Published and unpublished RCTs and quasi-RCTs were eligible for inclusion in this review, as were cluster-randomised and cross-over randomised trials that compared the effects of continuous versus intermittent bolus intragastric tube feeding on gastro-oesophageal reflux disease in preterm and low birth weight infants.
Two review authors independently assessed study eligibility and quality. We planned to use the GRADE approach to assess the certainty of evidence.
We found no trials that met the inclusion criteria for this review.