Preterm babies benefit from early milk feeds

Preterm babies who are small for their age would benefit from starting milk feeds early, according to a breakthrough UK study published online in Pediatrics earlier this month. The UK-based children's charity, Action Medical Research, sponsored the study. They told the press the findings could change the way preterm babies are fed in hospitals and may result in the infants being able to leave specialist care units earlier. The trial involved over 400 preterm babies and took place at 54 hospitals throughout the UK and Ireland. It is the largest to date that has examined milk feeding in high-risk preterm infants. High-risk preterm babies are vulnerable to several bowel complications, which has resulted in the tendency to delay the start of "enteral" milk feeding, that is giving them milk by mouth, so it enters the digestive tract. Instead, they are kept in specialist neonatal units and fed fluids and nutrients through an intravenous drip. But the results of this trial, led by Dr Alison Leaf, who was Consultant Neonatologist and Professor Peter Brocklehurst, who was at the National Perinatal Epidemiology Unit, both at the University of Oxford, when they worked on the trial, suggest these high-risk preterm infants would generally benefit from starting milk feeds within the first 24 to 48 hours after being born. Action Medical Research suggest the findings should make doctors and nurses more confident about starting to feed these high-risk infants earlier. The researchers say it may also result in babies being able to leave specialist care earlier, thus releasing vital high dependency cots for others. The researchers defined preterm as being born before 35 weeks of gestation, and being small for their age, or "growth restricted", as having a birth weight below the 10th centile. Leaf, now an Academic Consultant at the National Institute for Health Research, Southampton Biomedical Research Centre, with the University Hospital and the University of Southampton, told the press: "These babies are a challenge to feed. Good nutrition and growth is very important, however their body organs, including the bowel, are immature. They often do not cope well with milk, and may develop severe bowel inflammation, a condition called necrotising enterocolitis (NEC), which can make them very ill." This is why milk feeds are often delayed and they are fed intravenously instead, she added. But this form of feeding is also risky, and can lead to infection and liver inflammation. "Until now, nobody had tested whether it is better to start milk feeds early or to delay, so the project was designed to answer this question," said Leaf. For the trial, half the 404 babies were randomly assigned to start "early" milk feeds on day 2 after birth, while the other half started "late" feeds on day 6. Nearly half of the babies needed respiratory support, but very sick babies were not included in the trial. The feeds were gradually increased at the same rate for both groups. Most of the babies received their mother's breast milk when they started milk feeds, rather than donor or formula milk. The results showed that the babies in the early milk feed group achieved full feeding earlier. On average, their intravenous feed drip could be removed three days earlier than those of the babies in the late feeding group. There was also no difference between the groups in the number of infants with severe bowel problems, including NEC. The researchers conclude: "Early introduction of enteral feeds in growth-restricted preterm infants results in earlier achievement of full enteral feeding and does not appear to increase the risk of NEC." Brocklehurst is now Director of the Institute for Women's Health at University College, He said: "This research will enable more high risk premature babies to be fed early, and to achieve full feeding earlier. This will reduce the need for intravenous drips and infusions." "It will also reduce the duration of occupancy of a high-dependency cot, which will free up resources for other sick babies, thus providing benefit for a wider population of sick infants," he added. The researchers say their findings will result in clearer guidelines on feeding babies in neonatal units throughout the UK, and potentially worldwide. The trial has also laid the groundwork for future research into how best to feed and nourish preterm and vulnerable babies.