Minimal enteral nutrition for promoting feeding tolerance and preventing morbidity in parenterally fed infants

Abstract

Background: Because of concern that feedings may increase the risk of necrotizing enterocolitis, some high-risk infants have received prolonged periods of parenteral nutrition without enteral feedings. Providing minimal enteral feedings during this period of parenteral nutrition was developed as a strategy to enhance feeding tolerance and decrease time to reach full feedings.

Objectives: For high-risk neonates receiving parenteral feedings, to assess the effect of minimal enteral nutrition (MEN) compared to no enteral nutrient intake on measures of feeding tolerance and neonatal outcome.

Search strategy: Searches were performed of the Oxford Database of Perinatal Trials, MEDLINE, abstracts and conference proceedings, references from relevant publications in the English language, and studies identified by personal communication.

Selection criteria: Only randomized or quasi-randomized clinical trials were considered. Trials were included if they enrolled high-risk infants randomly assigned to receive minimal enteral feedings (defined as dilute or full strength feedings providing <= 25 kcal/kg/d for >= 5d) or no enteral nutrient intake (no feedings or water only).

Data collection and analysis: The two reviewers reached consensus for inclusion of trials. Data regarding clinical outcomes were extracted and evaluated by the two reviewers independently of each other. Authors were contacted as needed and feasible to clarify or provide missing data. The specific data that were needed were requested in writing.

Main results: Among infants given minimal enteral nutrition (MEN), there was an overall reduction in days to full enteral feeding, total days that feedings were held, and total hospital stay. There was no discernible effect on necrotizing enterocolitis.

Reviewer's conclusions: The evidence of benefit from MEN in these analyses is not convincing for a variety of reasons--the inherent difficulty of assessing enteral feedings in high-risk infants, the small size and methodologic limitations of the studies to date, unexplained heterogeneity with respect to some of the apparent benefits, the potential for bias to affect the findings in unblinded studies, and the unexcluded possibility that MEN might increase necrotizing enterocolitis. For these reasons, it is unclear whether MEN should be used in lieu of an equal period of time without enteral feedings.