Feeding infants below 29 weeks' gestation with abnormal antenatal Doppler: analysis from a randomised trial

Arch Dis Child Fetal Neonatal Ed. 2014 Jan;99(1):F6-F11. doi: 10.1136/archdischild-2013-304393. Epub 2013 Aug 23.


Objective: To describe feeding and gastrointestinal outcomes in growth-restricted infants <29 weeks' gestation and to determine the rate of feed advancement which they tolerate.

Design: Analysis of prospectively collected data from a randomised feeding trial, the Abnormal Doppler Enteral Prescription Trial (ADEPT).

Setting: 54 neonatal units in the UK and Ireland.

Participants: 404 preterm, growth-restricted infants with abnormal antenatal Doppler studies from ADEPT. 83 infants <29 weeks and 312 infants ≥ 29 weeks' gestation were included in this analysis.

Interventions: In ADEPT, infants were randomised to start milk 'early' on day 2 after birth, or 'late' on day 6. Subsequent feed advancement followed a regimen, which should have achieved full feeds by day 16 in the early and day 20 in the late group.

Main outcome measures: Full feeds were achieved later in infants <29 weeks; median age 28 days {IQR 22-40} compared with 19 days {IQR 17-23} in infants ≥ 29 weeks (HR 0.35, 95% CI 0.3 to 0.5). The incidence of necrotising enterocolitis was also higher in this group; 32/83 (39%) compared to 32/312 (10%) in those ≥ 29 weeks (RR 3.7, 95% CI 2.4 to 5.7). Infants <29 weeks tolerated very little milk for the first 10 days of life and reached full feeds 9 days later than predicted from the trial regimen.

Conclusions: Growth-restricted infants born <29 weeks' gestation with abnormal antenatal Doppler failed to tolerate even the careful feeding regimen of ADEPT. A slower advancement of feeds may be required for these infants.

Trial registration number: ISRCTN87351483.

Keywords: Fetal Medicine; Gastroenterology; Neonatology; Nutrition.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Breast Feeding*
  • Enteral Nutrition / adverse effects*
  • Enteral Nutrition / methods
  • Enterocolitis, Necrotizing / etiology*
  • Female
  • Fetal Growth Retardation / diagnostic imaging
  • Fetal Growth Retardation / therapy*
  • Gestational Age
  • Humans
  • Infant Formula / administration & dosage*
  • Infant, Newborn
  • Infant, Premature*
  • Infant, Premature, Diseases / diagnostic imaging
  • Infant, Premature, Diseases / therapy*
  • Infant, Very Low Birth Weight
  • Ireland
  • Male
  • Pregnancy
  • Prospective Studies
  • Time Factors
  • Treatment Outcome
  • Ultrasonography, Prenatal
  • United Kingdom

Associated data

  • ISRCTN/ISRCTN87351483