Slow verses rapid advancement of enteral feed in preterm neonates of 28-34 weeks of gestational age with abnormal antenatal umbilical artery Doppler: A randomised controlled trial

Background: Necrotising enterocolitis (NEC) is the commonest and most serious gastrointestinal neonatal emergency. In preterm infants with evidence of abnormal Doppler flow velocities in the fetal umbilical artery, suboptimal intestinal perfusion is postulated to increase the risk of feed intolerance and NEC.Objectives: To compare the effect of slow versus rapid enteral feeding in preterm neonates with abnormal antenatal umbilical artery Doppler.Method: This is a randomised controlled trial; we randomised into a slow and a fast group; we randomised separately into subcategories based on the weight. Sample size was calculated as 82. Data analysis was done using SPSS version 23. For group comparisons of categorical data, Chi-squared test was used. If expected frequency in the contingency tables was <5 for more than 25% cells, Fisher’s exact test was used. For non-parametric continuous data Mann-Whitney test was applied. Statistical significance was kept at p<0.05 and power at 80%.Results: In neonates with slow and rapid feeding with birth weight <1250g, percentage of 2b (30% and 26.7% respectively) was more compared to other stages, whereas in group with birth weight ≥1250g rapid feeding group Ia (14.3%) was more in slow feeding group and 1a and 2a equal in rapid feeding group with no statistical significance. The mean duration of stay hospital was less in rapid feeding group in both birth strata. The sepsis percentage was more in the slow feeding group. Regarding mortality in both groups, there was no statistical difference.Conclusions: In this study the type of feeding did not affect NEC or feeding intolerance in preterm infants. Rapid feeding had a significant impact on sepsis and length of stay in preterm infants.