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Meta-Analysis
. 2011 Nov 9;2011(11):CD001819.
doi: 10.1002/14651858.CD001819.pub2.

Continuous nasogastric milk feeding versus intermittent bolus milk feeding for premature infants less than 1500 grams

Shahirose S Premji  1 , Lorraine Chessell
Affiliations
Meta-Analysis

Continuous nasogastric milk feeding versus intermittent bolus milk feeding for premature infants less than 1500 grams

Shahirose S Premji et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Milk feedings can be given via nasogastric tube either intermittently, typically over 10 to 20 minutes every two or three hours, or continuously, using an infusion pump. Although theoretical benefits and risks of each method have been proposed, effects on clinically important outcomes remain uncertain.

Objectives: To examine the evidence regarding the effectiveness of continuous versus intermittent bolus nasogastric milk feeding in premature infants less than 1500 grams.

Search methods: Searches were performed of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2011), MEDLINE, CINAHL and HealthSTAR up to July 2011.

Selection criteria: Randomised and quasi-randomised clinical trials comparing continuous versus intermittent bolus nasogastric milk feeding in premature infants less than 1500 grams.

Data collection and analysis: Two review authors independently assessed all trials for relevance and methodologic quality. The standard methods of the Cochrane Neonatal Review Group were used to extract data.

Main results: Overall, the seven included trials, involving 511 infants, found no differences in time to achieve full enteral feeds between feeding methods (weighted mean difference (WMD) 2 days; 95% CI -0.3 to 3.9) . In the subgroup analysis of those studies comparing continuous nasogastric versus intermittent bolus nasogastric milk feedings the findings remained unchanged (WMD 2 days, 95% CI -0.4 to 4.1). There was no significant difference in somatic growth and incidence of NEC between feeding methods irrespective of tube placement. One study noted a trend toward more apneas during the study period in infants fed by the continuous tube feeding method compared to those fed by intermittent feedings delivered predominantly by orogastric tube placements [mean difference (MD) 14.0 apneas during study period; 95% CI -0.2 to 28.2]. In subgroup analysis based on weight groups, one study suggested that infants less than 1000 grams and 1000 to 1250 grams birth weight gained weight faster when fed by the continuous nasogastric tube feeding method compared to intermittent nasogastric tube feeding method (MD 2.0 g/day; 95% CI 0.5 to 3.5; MD 2.0 g/day; 95% CI 0.2 to 3.8, respectively). A trend toward earlier discharge for infants less than 1000 grams birth weight fed by the continuous tube feeding method compared to intermittent nasogastric tube feeding method (MD -11 days; 95% CI -21.8 to -0.2).

Authors' conclusions: Small sample sizes, methodologic limitations, inconsistencies in controlling variables that may affect outcomes, and conflicting results of the studies to date make it difficult to make universal recommendations regarding the best tube feeding method for premature infants less than 1500 grams. The clinical benefits and risks of continuous versus intermittent nasogastric tube milk feeding cannot be reliably discerned from the limited information available from randomised trials to date.

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Conflict of interest statement

None

Figures

1.1
1.1. Analysis
Comparison 1 Continuous versus intermittent bolus (nasogastric and orogastric tube) milk feeding ‐ all infants, Outcome 1 Feeding performance.
1.2
1.2. Analysis
Comparison 1 Continuous versus intermittent bolus (nasogastric and orogastric tube) milk feeding ‐ all infants, Outcome 2 Growth.
1.3
1.3. Analysis
Comparison 1 Continuous versus intermittent bolus (nasogastric and orogastric tube) milk feeding ‐ all infants, Outcome 3 Utilization of resources.
1.4
1.4. Analysis
Comparison 1 Continuous versus intermittent bolus (nasogastric and orogastric tube) milk feeding ‐ all infants, Outcome 4 Complications (categorical).
1.5
1.5. Analysis
Comparison 1 Continuous versus intermittent bolus (nasogastric and orogastric tube) milk feeding ‐ all infants, Outcome 5 Complications (continuous).
2.1
2.1. Analysis
Comparison 2 Continuous versus intermittent bolus (nasogastric tube) milk feeding ‐ all infants, Outcome 1 Feeding performance.
2.2
2.2. Analysis
Comparison 2 Continuous versus intermittent bolus (nasogastric tube) milk feeding ‐ all infants, Outcome 2 Growth.
2.3
2.3. Analysis
Comparison 2 Continuous versus intermittent bolus (nasogastric tube) milk feeding ‐ all infants, Outcome 3 Utilization of resources.
2.4
2.4. Analysis
Comparison 2 Continuous versus intermittent bolus (nasogastric tube) milk feeding ‐ all infants, Outcome 4 Complications (categorical).
2.5
2.5. Analysis
Comparison 2 Continuous versus intermittent bolus (nasogastric tube) milk feeding ‐ all infants, Outcome 5 Complications (continuous).
3.1
3.1. Analysis
Comparison 3 Continuous versus intermittent bolus (nasogastric and orogastric tube) milk feeding in infants < 1000g, Outcome 1 Feeding performance.
3.2
3.2. Analysis
Comparison 3 Continuous versus intermittent bolus (nasogastric and orogastric tube) milk feeding in infants < 1000g, Outcome 2 Growth.
3.3
3.3. Analysis
Comparison 3 Continuous versus intermittent bolus (nasogastric and orogastric tube) milk feeding in infants < 1000g, Outcome 3 Utilization of resources.
3.4
3.4. Analysis
Comparison 3 Continuous versus intermittent bolus (nasogastric and orogastric tube) milk feeding in infants < 1000g, Outcome 4 Complications (categorical).
4.1
4.1. Analysis
Comparison 4 Continuous versus intermittent bolus (nasogastric tube) milk feeding in infants < 1000g, Outcome 1 Feeding performance.
4.2
4.2. Analysis
Comparison 4 Continuous versus intermittent bolus (nasogastric tube) milk feeding in infants < 1000g, Outcome 2 Growth.
4.3
4.3. Analysis
Comparison 4 Continuous versus intermittent bolus (nasogastric tube) milk feeding in infants < 1000g, Outcome 3 Utilization of resources.
5.1
5.1. Analysis
Comparison 5 Continuous versus intermittent bolus (nasogastric tube) milk feeding in infants > 1000g and < 1249g, Outcome 1 Feeding performance.
5.2
5.2. Analysis
Comparison 5 Continuous versus intermittent bolus (nasogastric tube) milk feeding in infants > 1000g and < 1249g, Outcome 2 Growth.
5.3
5.3. Analysis
Comparison 5 Continuous versus intermittent bolus (nasogastric tube) milk feeding in infants > 1000g and < 1249g, Outcome 3 Utilization of resources.
6.1
6.1. Analysis
Comparison 6 Continuous versus intermittent bolus (nasogastric tube) milk feeding in infants > 1250g and < 1499g, Outcome 1 Feeding performance.
6.2
6.2. Analysis
Comparison 6 Continuous versus intermittent bolus (nasogastric tube) milk feeding in infants > 1250g and < 1499g, Outcome 2 Growth.
6.3
6.3. Analysis
Comparison 6 Continuous versus intermittent bolus (nasogastric tube) milk feeding in infants > 1250g and < 1499g, Outcome 3 Utilization of resources.
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Update of

References

References to studies included in this review

Akintorin 1997 {published data only}
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Dollberg 2000 {published and unpublished data}
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Dsilna 2005 {published and unpublished data}
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Macdonald 1992 {published and unpublished data}
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References to studies excluded from this review

Baker 1997 {published data only}
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References to other published versions of this review

Premji 2001
    1. Premji S, Chessell L. Continuous nasogastric milk feeding versus intermittent bolus milk feeding for premature infants less than 1500 grams. Cochrane Database of Systematic Reviews 2001, Issue 1. [DOI: 10.1002/14651858.CD001819] - DOI - PubMed
Premji 2003
    1. Premji S, Chessell L. Continuous nasogastric milk feeding versus intermittent bolus milk feeding for premature infants less than 1500 grams. Cochrane Database of Systematic Reviews 2003, Issue 1. [DOI: 10.1002/14651858.CD001819] - DOI - PubMed
Premji 2004
    1. Premji S, Chessell L. Continuous nasogastric milk feeding versus intermittent bolus milk feeding for premature infants less than 1500 grams. Cochrane Database of Systematic Reviews 2004, Issue 4. [DOI: 10.1002/14651858.CD001819] - DOI - PMC - PubMed

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