Higher or Usual Volume Feedings in Very Preterm Infants: A Randomized Clinical Trial

J Pediatr. 2020 May 25;S0022-3476(20)30624-7. doi: 10.1016/j.jpeds.2020.05.033. Online ahead of print.


Objective: To determine if higher volume feedings improve postnatal growth among very preterm infants.

Study design: Randomized clinical trial with 1:1 parallel allocation conducted from 1/2015 to 6/2018 in a single academic medical center in the United States. 224 infants with a birth weight 1001-2500 grams born at <32 weeks of gestation were randomized to higher (180-200 mL/kg/day) or usual volume feedings (140-160 mL/kg/day) after establishing full enteral feedings (≥120 mL/kg/day). The primary outcome was growth velocity (g/kg/day) from randomization to study completion at 36 weeks of postmenstrual age or hospital discharge if earlier.

Results: Growth velocity increased among infants in the higher volume group compared with the usual volume group (mean [SD], 20.5 [4.5] versus 17.9 [4.5] g/kg/day; p<0.001). At study completion, all measurements were higher among infants in the higher volume group compared with the usual volume group; weight (2365 [324] g, Z-score -0.60 [0.73] versus 2200 [308] g, Z-score -0.94 [0.71]; p<0.001); head circumference (31.9 [1.3] cm, Z-score -0.30 [0.91] versus 31.4 [1.3] cm, Z-score -0.53 [0.84]; p=0.01); length (44.9 [2.1] cm, Z-score -0.68 [0.88] versus 44.4 [2.0], Z-score -0.83 [0.84]; p=0.04); and mid-arm circumference (8.8 [0.8] cm versus 8.4 [0.8] cm; p=0.002). Bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, or other adverse outcomes did not differ between groups.

Conclusion(s): In very preterm infants weighing 1001-2500 grams at birth, higher volume feedings increased growth velocity, weight, head circumference, length, and mid-arm circumference compared with usual volume feedings without adverse effects.