COMPARATIVE ANALYSIS OF INTERMITTENT BOLUS VERSUS CONTINUOUS NASOGASTRIC FEEDING IN PRETERM INFANTS
Objective: To compare the effectiveness and complications of bolus versus continuous tube feeding in pre-term newborns <1500 grams.
Study Design: Quasi-experimental study
Place and Duration of Study: Neonatology Department of Pakistan Institute of Medical Sciences Islamabad, from Nov 2014 to Mar 2016.
Methodology: A total of 60 pre-terms; <34 weeks meeting the inclusion criteria, were included in the study and grouped according to birth weight; group A between 1000 to 1250 grams, and group B between 1250 to 1500 grams. Newborns from each group were randomly selected for bolus feeds given intermittently after every 2 hours, and continuous feed given with infusion pump. All infants were maintained in closed incubators until they weighed approximately 1800 g and the neonatal staff followed standard nursery protocols other than for feeding.
Results: There were 10 patients (9 in the bolus group and 1 in the continuous group) who did not reach the end point of 150 mL/Kg/day. One was transferred to another hospital before completing the protocol; 2 were diagnosed with congenital syphilis and Rubella syndrome; 1 switched to breast feeding due to parental concerns; 1 required the surgery for intestinal malrotation, and 5 died. The number of days to achieve full feeding calculated from the initiation of feeding was not significantly different between the groups. The main daily gastric residual volumes were significantly lower in the continuous group than in the bolus group, as was the total number of patients with feeding interruptions.
Conclusion: Birth weight was inversely related to days to achieve full enteral feeding. The method of feeding was not associated with differences in outcome when similar energy intakes were provided and when guidelines for discontinuation of feedings are followed.