AAP 2021: slow vs fast progression of diet in low birth weight preterm infants | DietDF

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Premature and low birth weight babies are at increased risk of necrotizing enterocolitis and food intolerance. The slow advance of enteral feeding can prevent necrotizing enterocolitis, but it can also increase the risk of infections and liver diseases secondary to prolonged parenteral nutrition.

A very interesting study presented in AAP Trip 2021, congress of American Academy of Pediatrics, demonstrated that the supreme rate of feed advancement remains obscure in clinical practice.

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Diet in preterms with low weight

Methods: data search in Medline, Scopus, Web of Science, CINAHL and Index Medicus, in order to identify randomized clinical trials that compared the effects of slow versus fast advance rates on mortality, morbidity, growth and neurodevelopmental outcomes.

Data from eligible studies were systematically extracted and the relative risks or mean differences were pooled comparing the advancement of slow versus fast feeding using random effects meta-analysis. They assessed the quality of each study using the Cochrane Risk of Bias 2 tool and summarized the overall quality of the evidence using the Grading of Recommendations, Evaluation, Development, and Evaluations (GRADE) method.

Results

3,174 studies were identified in the search and 12 that were eligible for inclusion. The slow advance of feeding did not affect the risk of mortality, risk of necrotizing enterocolitis, risk of food intolerance, risk of sepsis or risk of apnea. Infants in sluggish feeding groups took 2 additional days to regain body weight at birth and spend 2 additional days in the scientific institution compared to those in sluggish feeding groups.

Subgroup analysis found similar results among babies with imperfect birth weight at 1000g. Furthermore, the effect of bad slow advance of feeding on mortality, necrotizing enterocolitis, sepsis and intolerance to feeding did not differ absolute ruin quantity bad advance of diet.

Read also: Restrictive transfusion strategy vs. liberal: recommendations for NB with extremely low birth weight Conclusions

Premature and low birth weight newborns fed slowly regained body weight at late birth and had longer hospital stays without reducing the risk of mortality and morbidity compared to faster-fed infants.

Concluding, rapid advancement of enteral feeding should be adopted with caution among clinically stable preterm and low birth weight babies.

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    Author:

    Graduated in Medicine at UNIGRANRIO ⦁ Medical Residency in Pediatrics at the General Health center of Nova Iguaçu ⦁ Specialist in Neonatology at the Brazilian Society of Pediatrics ⦁ Postgraduate studies in Pediatric and Neonatal Intensive Medicine at Faculdade Redentor ⦁ Currently Ruin Coordinator Pediatrics Service of Santa Casa de Barra Mansa ⦁ Has experience in Neonatal and Pediatric Intensive Care and Pediatrics.

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