Safety of Full Enteral Feedings Initiated Soon after Birth Instead of Parenteral Fluids in Clinically Stable 30–34 Weeks Gestation Premature Infants
Angela B Hoyos, Pablo Vasquez-Hoyos
Keywords :
Central venous lines, Early oral feeds, Hospital-acquired infections, Late premature infants, Newborn, Neonate, Nutrition, Parenteral fluids, Umbilical lines, Z-score
Citation Information :
Hoyos AB, Vasquez-Hoyos P. Safety of Full Enteral Feedings Initiated Soon after Birth Instead of Parenteral Fluids in Clinically Stable 30–34 Weeks Gestation Premature Infants. 2024; 3 (3):190-194.
Background: Many neonatal intensive care units use feeding protocols where infants born at 30–34 weeks’ gestation are maintained exclusively on parenteral fluids for variable periods without enteral feedings, until there is confirmed hemodynamic stability without any doubt. In addition to the pain and discomfort, intravenous infusions are associated with an increased risk of hospital-acquired infections, which makes it an undesirable practice if not essential.
Objective: In this quality improvement (QI) effort, we tested the safety and efficacy of enteral feedings starting within the first 2 hours after birth in infants born at 30–34 weeks’ gestation.
Materials and methods: Instead of intravenous fluids, we initiated fluid management in infants born at 30–34 weeks’ gestation using oral/nasogastric milk feedings at 70–80 mL/kg/day divided every 3 hours, with 5 mL increments every 12–24 hours until 200 mL/kg/day was achieved. We compared the utilization of parenteral fluids, the incidence of infection, and growth before and after initiation of this new feeding policy.
Results: In our experience, these infants tolerated and utilized enteral feedings well with stable growth and biochemical parameters. They also tolerated daily volume increments in the enteral feedings. We did not find any hypoglycemic events as the first enteral feeding was administered within 2 hours after birth. The enterally fed group showed a similar safety profile with similar weight at discharge and weight Z-scores. We report that infants born as early as 30 weeks gestation can safely tolerate ab initio full enteral feedings.
Conclusion: Enteral feedings beginning within 2 hours after birth are a safe and efficacious strategy for fluid management in premature infants born at 30–34 weeks gestation. Routine use of parenteral fluids is not necessary in the initial management of these infants.
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