Another Study Questions the Efficacy of Drip Feeds for Reflux

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.

Key finding:

  • 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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Increased Intestinal Blood Flow with Bolus Feedings in Very Low Birth Weight Infants

From Journal of Pediatrics:  V Bozzetti et al. DOI: http://dx.doi.org/10.1016/j.jpeds.2016.05.031

Abstract:

Objective

To detect changes in splanchnic perfusion and oxygenation induced by 2 different feeding regimens in infants with intrauterine growth restriction (IUGR) and those without IUGR.

Study design

This was a randomized trial in 40 very low birth weight infants. When an enteral intake of 100 mL/kg/day was achieved, patients with IUGR and those without IUGR were randomized into 2 groups. Group A (n = 20) received a feed by bolus (in 10 minutes), then, after at least 3 hours, received the same amount of formula by continuous nutrition over 3 hours. Group B (n = 20) received a feed administered continuously over 3 hours, followed by a bolus administration (in 10 minutes) of the same amount of formula after at least 3 hours. On the day of randomization, intestinal and cerebral regional oximetry was measured via near-infrared spectroscopy and Doppler ultrasound (US) of the superior mesenteric artery was performed. Examinations were performed before the feed and at 30 minutes after the feed by bolus and before the feed, at 30 minutes after the start of the feed, and at 30 minutes after the end of the feed for the 3-hour continuous feed.

Results

Superior mesenteric artery Doppler US showed significantly higher perfusion values after the bolus feeds than after the continuous feeds. Near-infrared spectroscopy values remained stable before and after feeds. Infants with IUGR and those without IUGR showed the same perfusion and oxygenation patterns.

Conclusion

According to our Doppler US results, bolus feeding is more effective than continuous feeding in increasing splanchnic perfusion.

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