Several years ago, a small study showed that bolus feeds were as well-tolerated in premature infants as drip feeds: Which is Safer -Drip Feeds of Bolus Feeds for Preterm Infants?
Now, a retrospective study (LB Mahoney, E Liu, R Rosen. JPGN 2019; 69: 678-81) found no difference in the rate of reflux in 18 children who were with gastrostomy-tube dependent.
In this study, 24-hour multichannel intraluminal impedance with pH monitoring (MII-pH) examine reflux events in children receiving exclusive enteral nutrition with a combination of daytime bolus feeds and overnight continuous feeds; each patient served as their own control. this included 6 with prior fundoplication.
- There was no difference in rate of reflux events when comparing bolus feedings and drip (aka continuous) feedings.
The limitations in this study include the small sample size and retrospective design. The authors estimate that to achieve adequate power (80% power) to detect a risk ratio of 1.2 would require 211 patients.
My take: This study and other small studies challenge the assumption that drip feedings are safer. Though, until a larger prospective study is performed, we will not know.
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