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Controlled Trial of Two Incremental Milk-Feeding Rates in Preterm Infants.
Dorling, Jon; Abbott, Jane; Berrington, Janet; Bosiak, Beth; Bowler, Ursula; Boyle, Elaine; Embleton, Nicholas; Hewer, Oliver; Johnson, Samantha; Juszczak, Edmund; Leaf, Alison; Linsell, Louise; McCormick, Kenny; McGuire, William; Omar, Omar; Partlett, Christopher; Patel, Mehali; Roberts, Tracy; Stenson, Ben; Townend, John.
Afiliação
  • Dorling J; From the Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, NS, Canada (J.D.); and Bliss, London (J.A., M.P.), the National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford (B.B., U.B., O.H., E.J., L.L., O.O., C.P.,
  • Abbott J; From the Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, NS, Canada (J.D.); and Bliss, London (J.A., M.P.), the National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford (B.B., U.B., O.H., E.J., L.L., O.O., C.P.,
  • Berrington J; From the Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, NS, Canada (J.D.); and Bliss, London (J.A., M.P.), the National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford (B.B., U.B., O.H., E.J., L.L., O.O., C.P.,
  • Bosiak B; From the Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, NS, Canada (J.D.); and Bliss, London (J.A., M.P.), the National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford (B.B., U.B., O.H., E.J., L.L., O.O., C.P.,
  • Bowler U; From the Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, NS, Canada (J.D.); and Bliss, London (J.A., M.P.), the National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford (B.B., U.B., O.H., E.J., L.L., O.O., C.P.,
  • Boyle E; From the Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, NS, Canada (J.D.); and Bliss, London (J.A., M.P.), the National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford (B.B., U.B., O.H., E.J., L.L., O.O., C.P.,
  • Embleton N; From the Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, NS, Canada (J.D.); and Bliss, London (J.A., M.P.), the National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford (B.B., U.B., O.H., E.J., L.L., O.O., C.P.,
  • Hewer O; From the Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, NS, Canada (J.D.); and Bliss, London (J.A., M.P.), the National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford (B.B., U.B., O.H., E.J., L.L., O.O., C.P.,
  • Johnson S; From the Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, NS, Canada (J.D.); and Bliss, London (J.A., M.P.), the National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford (B.B., U.B., O.H., E.J., L.L., O.O., C.P.,
  • Juszczak E; From the Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, NS, Canada (J.D.); and Bliss, London (J.A., M.P.), the National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford (B.B., U.B., O.H., E.J., L.L., O.O., C.P.,
  • Leaf A; From the Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, NS, Canada (J.D.); and Bliss, London (J.A., M.P.), the National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford (B.B., U.B., O.H., E.J., L.L., O.O., C.P.,
  • Linsell L; From the Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, NS, Canada (J.D.); and Bliss, London (J.A., M.P.), the National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford (B.B., U.B., O.H., E.J., L.L., O.O., C.P.,
  • McCormick K; From the Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, NS, Canada (J.D.); and Bliss, London (J.A., M.P.), the National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford (B.B., U.B., O.H., E.J., L.L., O.O., C.P.,
  • McGuire W; From the Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, NS, Canada (J.D.); and Bliss, London (J.A., M.P.), the National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford (B.B., U.B., O.H., E.J., L.L., O.O., C.P.,
  • Omar O; From the Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, NS, Canada (J.D.); and Bliss, London (J.A., M.P.), the National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford (B.B., U.B., O.H., E.J., L.L., O.O., C.P.,
  • Partlett C; From the Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, NS, Canada (J.D.); and Bliss, London (J.A., M.P.), the National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford (B.B., U.B., O.H., E.J., L.L., O.O., C.P.,
  • Patel M; From the Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, NS, Canada (J.D.); and Bliss, London (J.A., M.P.), the National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford (B.B., U.B., O.H., E.J., L.L., O.O., C.P.,
  • Roberts T; From the Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, NS, Canada (J.D.); and Bliss, London (J.A., M.P.), the National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford (B.B., U.B., O.H., E.J., L.L., O.O., C.P.,
  • Stenson B; From the Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, NS, Canada (J.D.); and Bliss, London (J.A., M.P.), the National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford (B.B., U.B., O.H., E.J., L.L., O.O., C.P.,
  • Townend J; From the Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, NS, Canada (J.D.); and Bliss, London (J.A., M.P.), the National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford (B.B., U.B., O.H., E.J., L.L., O.O., C.P.,
N Engl J Med ; 381(15): 1434-1443, 2019 10 10.
Article em En | MEDLINE | ID: mdl-31597020
ABSTRACT

BACKGROUND:

Observational data have shown that slow advancement of enteral feeding volumes in preterm infants is associated with a reduced risk of necrotizing enterocolitis but an increased risk of late-onset sepsis. However, data from randomized trials are limited.

METHODS:

We randomly assigned very preterm or very-low-birth-weight infants to daily milk increments of 30 ml per kilogram of body weight (faster increment) or 18 ml per kilogram (slower increment) until reaching full feeding volumes. The primary outcome was survival without moderate or severe neurodevelopmental disability at 24 months. Secondary outcomes included components of the primary outcome, confirmed or suspected late-onset sepsis, necrotizing enterocolitis, and cerebral palsy.

RESULTS:

Among 2804 infants who underwent randomization, the primary outcome could be assessed in 1224 (87.4%) assigned to the faster increment and 1246 (88.7%) assigned to the slower increment. Survival without moderate or severe neurodevelopmental disability at 24 months occurred in 802 of 1224 infants (65.5%) assigned to the faster increment and 848 of 1246 (68.1%) assigned to the slower increment (adjusted risk ratio, 0.96; 95% confidence interval [CI], 0.92 to 1.01; P = 0.16). Late-onset sepsis occurred in 414 of 1389 infants (29.8%) in the faster-increment group and 434 of 1397 (31.1%) in the slower-increment group (adjusted risk ratio, 0.96; 95% CI, 0.86 to 1.07). Necrotizing enterocolitis occurred in 70 of 1394 infants (5.0%) in the faster-increment group and 78 of 1399 (5.6%) in the slower-increment group (adjusted risk ratio, 0.88; 95% CI, 0.68 to 1.16).

CONCLUSIONS:

There was no significant difference in survival without moderate or severe neurodevelopmental disability at 24 months in very preterm or very-low-birth-weight infants with a strategy of advancing milk feeding volumes in daily increments of 30 ml per kilogram as compared with 18 ml per kilogram. (Funded by the Health Technology Assessment Programme of the National Institute for Health Research; SIFT Current Controlled Trials number, ISRCTN76463425.).
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Recém-Nascido Prematuro / Deficiências do Desenvolvimento / Nutrição Enteral / Recém-Nascido de muito Baixo Peso / Fórmulas Infantis / Doenças do Prematuro / Leite Humano Tipo de estudo: Clinical_trials / Health_technology_assessment / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Child, preschool / Humans / Newborn Idioma: En Ano de publicação: 2019 Tipo de documento: Article
Texto completo
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PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Recém-Nascido Prematuro / Deficiências do Desenvolvimento / Nutrição Enteral / Recém-Nascido de muito Baixo Peso / Fórmulas Infantis / Doenças do Prematuro / Leite Humano Tipo de estudo: Clinical_trials / Health_technology_assessment / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Child, preschool / Humans / Newborn Idioma: En Ano de publicação: 2019 Tipo de documento: Article