A
Here’s a bullet-gist of the article titled “Full exclusively enteral fluids from day 1 versus gradual milk feeding” (in the journal The Lancet Child & Adolescent Health) by S Ojha et al. (The Lancet)
-
Population: Preterm infants (gestational age ~30 +0 to 32 +6 weeks) in multiple UK neonatal units. (The Lancet)
-
Intervention: Starting full enteral milk feeds from day 1 (≈60–80 mL/kg/day) versus gradual milk feed build-up (max ~30 mL/kg/day on day 1). (The Lancet)
-
Primary question: Does initiating full enteral feeding from day 1 improve outcomes compared to slow increase?
-
Key findings: The trial found no statistically significant increase in adverse events from full feeds, and some evidence of faster achievement of feeding volumes; but caution remains about risk of feeding intolerance/necrotising enterocolitis.
-
Implications: Suggests that for moderately preterm infants, early full enteral feeding may be feasible and safe under appropriate monitoring, and might shorten time to full feeds, reduce parenteral nutrition exposure.
-
Caveats: Trial presumably under specific settings (UK neonatal units), so generalisability to more premature infants or different settings may be limited.
-
Conclusion: Supports reconsideration of gradual feeding protocols in this gestational age group; invites further research for younger preterms.
If you like, I can dig into subgroup data, adverse-events, and clinical-practice implications more deeply.
A
Here’s a deeper dive into the FEED1 trial — Full exclusively enteral fluids from day 1 versus gradual milk feeding in preterm infants (published in The Lancet Child & Adolescent Health) (The Lancet)
Key details of the trial
-
Population: Infants born at 30 +0 to 32 +6 weeks’ gestation (inclusive) in the UK. (BioMed Central)
-
Design: Multi-centre, open-label, parallel-group randomised superiority trial. (feed1.ac.uk)
-
Recruitment: ~2,088 infants from 46 NHS hospitals in the UK. (EurekAlert!)
-
Intervention (“full enteral”): Start enteral milk feeds from day 1 (fluid via milk feed ~60 mL/kg/day) rather than initial IV/parenteral fluids plus slower increase of milk. (BioMed Central)
-
Comparator (“gradual feeding”): Usual care – IV fluids/parenteral nutrition + gradual milk feed increases. (BioMed Central)
-
Primary outcome: Length of hospital stay. Secondary outcomes: e.g., time to full feeds, time to regain birth weight, growth measures, incidence of NEC (Necrotising Enterocolitis) stage 2/3 until discharge, late-onset sepsis, IV line days, etc. (feed1.ac.uk)
Sub-group and secondary outcome details & findings
-
The article summary notes no significant increase in key adverse outcomes (NEC, late‐onset sepsis, hypoglycaemia) in the full enteral group compared to the gradual group. (EurekAlert!)
-
Evidence that infants in the full enteral group achieved full feeding volumes more quickly, spent fewer days on IV fluids and central lines. (Summary note: “fewer medical interventions” for full-feed group) (EurekAlert!)
-
For growth, weight gain, head circumference, length: protocol included these as secondary endpoints, though detailed numeric results are not publicly highlighted in the accessible abstract. (feed1.ac.uk)
-
For neurodevelopmental outcomes at 2 years corrected age: the protocol planned follow-up for this but the current publication likely reports short-term (discharge / 6-weeks) outcomes. (BioMed Central)
Clinical implications & practice considerations
-
The findings support that in moderately preterm infants (30–32 weeks) who are stable, initiating full enteral milk feeds from day 1 may be feasible and safe (in this trial setting) compared to the more conservative gradual feeding + IV fluids approach.
-
Potential benefits: earlier transition to full enteral feeding → less IV access days, fewer invasive lines, likely reduced risk of IV‐associated complications/infections; possibly shorter hospital stay and earlier family / mother-infant bonding (since less medicalisation).
-
However: This does not mean unrestricted full feeding for all preterm infants. Caution remains for infants with additional risk factors (very low gestational age <30 weeks, GI anomalies, unstable cardiovascular/respiratory status). The trial population was 30 +0 to 32 +6 weeks and the centres were UK NHS neonatal units with high capability.
-
Adoption into practice should consider unit resources: ability to monitor for feeding intolerance, NEC, and ensure careful protocols and experience with early enteral feeding.
-
Also, because length of stay depends on multiple discharge-criteria beyond feeding (weight milestones, suck feeds, temperature stability), the effect on hospital stay may vary by local practice. The trial included a secondary outcome of time until objective discharge criteria met. (BioMed Central)
What we don’t yet know / limitations
-
The full numeric data for all secondary endpoints (growth parameters, time to full feeds, IV days, specific NEC incidence numbers) are not all publicly summarised in the abstract or press release I saw. I’d need full article access for detailed tables.
-
Long-term outcomes (2-year neurodevelopment) are still pending (or not reported yet).
-
Generalisability: The trial was in UK high-resource settings; applicability to lower resource settings or to more immature infants (<30 weeks) is uncertain.
-
The trial is open-label (feeds cannot be blinded), which is inherent in feeding studies but may influence decisions on discharge timing, though the “objective discharge criteria” secondary outcome aims to mitigate that.
-
While NEC risk was not increased in this cohort, the study may not have been powered to detect small differences in rare outcomes like NEC in this specific gestational group. The protocol noted larger sample sizes would be needed to robustly assess NEC incidence. (BioMed Central)
Bottom line
For infants born at ~30–32 weeks’ gestation in high-resource neonatal units, the FEED1 trial suggests that starting full enteral milk feeds from day one is probably safe, may reduce reliance on IV fluids and central lines, and could support earlier achievement of full feeds. It challenges the default conservative paradigm of very slow feed increment + IV fluids in this population. However, local unit protocols, infant stability, monitoring capacity, and long-term outcomes must be factored in before widespread change.
If you like, I can pull out the exact numbers for outcomes (e.g., median days to full feeds, NEC incidence, IV days) from the full article and send you a table of those.
No comments:
Post a Comment