Enteral feeding based on expected median weight versus actual weight among small for gestational age preterm infants born at 30-34 weeks of gestation for prevention of hypoglycemia: an assessor-blinded randomised controlled trial.

This study is to compare liberal feeding (LF) based on expected median weight with conventional feeding (CF) calculated on actual birth weight, among small for gestational age (SGA) neonates of 30-34 weeks of gestation, to reduce the incidence of hypoglycaemia in the first 7 days of postnatal age. In this single centre randomised controlled trial, a total of 82 neonates were allocated to LF (n = 41) and the CF group (n = 41). The intervention group (LF) was given feed volume based on their expected median weight as per the gestational age at birth, while the comparator group (CF) received feeding volume based on their actual birth weight. The primary outcome was to compare the incidence of hypoglycaemia in the first 7 days of life. Baseline characteristics were comparable in both groups. The LF group did not show a significant reduction in hypoglycaemic incidence among the participants; only there was a trend towards a lower incidence of hypoglycaemia in the LF group (2.4% vs. 17.1%, p = 0.057). Neonates in the LF group recovered birth weight (5.78 ± 2.83 d vs. 9.71 ± 3.29 d, p < 0.001) and achieved full feeding (6.16 ± 1.49 d vs. 8.26 ± 2.31 d, p < 0.001) earlier, as compared to the CF group. The groups did not differ significantly in terms of complications like feed intolerance, necrotising enterocolitis (≥ stage 2), sepsis, and death before discharge.

conclusionEnteral feeding based on expected median weight showed a non-significant decrease in the incidence of hypoglycaemia as compared to conventional feeding based on actual weight among SGA infants of 30-34 weeks of gestation. Liberal feeding was found to be feasible in such infants as it significantly helped to attain full feed and birth weight earlier among such neonates without any major side effects. Further large multicentric trials are needed to fully establish its efficacy and safety.

trial registrationThis trial was prospectively registered with Clinical Trial Registry-India ( https://ctri.nic.in/Clinicaltrials/login.php ) (CTRI/2024/03/064032) on 12th March 2024. WHAT IS KNOWN: • Early total enteral feeding from day 1 has been tried successfully in stable SGA preterm neonates. • No consensus exists regarding the highest tolerated volume of feeds for SGA neonates. WHAT IS NEW: • Liberal feeding with feeding volume based on gestation-specific expected median weight is a novel and safe feeding strategy in SGA preterm infants of 30-34 weeks and it helps to regain birth weight and to attain full enteral feeds earlier among such infants. • Such higher feed volume is well tolerated among SGA preterm infants of 30-34 weeks and does not increase the incidence of feed intolerance or necrotising enterocolitis (≥ stage 2).