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peavyk

Enteral feeds for ELBW infants

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 I am on a committee for enteral feeds for ELBW infants.  I've pulled some recent literature to see what I could find and there are conflicting viewpoints on whether feeds should advance more slowly or faster in ELBW infants.  What is your guideline for enteral feeds progression in the ELBW infant?

 

Kärsten

 

 

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Hi Karsten,

In Southampton, UK, we have a nutritional screening tool (high risk, medium risk, low risk) which guides us for increasing feeds. ELBW infants would be increasing between 10-20mls/kg/day of EBM. We usually start colostrum as available, then 0.5ml/ 4 hourly, increasing in 10-20mls/kg/day volumes. We are trying to start breast milk fortification at 100mls/kg/day though mostly at 120mls/kg/day. I hope this is helpful. Speed of Increasing Feed trial results later this year may also help guide practice. 🙂

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Hi,

In the hospitals I worked in Austria, the rule was to increase by 10-20ml/kg/d and start on first day. If Colostrum is available this is fed as well. We start with enteral feeds right away on the first day. We give 2-3 hourly feeds.

@Vicky Payne who is high/medium/low risk according to your tool?

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@Vicki Payne would you be able to share your screening tool? 

Currently our protocol is to start out with any available colostrum.  The problem is we don't deliver babies currently at this hospital so we rely on the transport team to bring us colostrum to start feeds with and that rarely happens (too busy with infant stabilization, outside hospital hasn't started mom pumping yet, indifferent attitude, etc.).  We will start delivering at the end of the year and should see a huge increase in available colostrum for first feeds.  If colostrum is not available and the mother has consented, then we start feeds with donor milk. 

We do advance at 10-20 mL/kg/day currently, but we're looking at new evidence and current practices at other facilities to see if we need to change our guidelines.  I was intrigued by this article (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001241.pub7/full) that discussed faster enteral feeding volumes possibly preventing NEC in the ELBW population.  Since I'm on the ELBW committee and haven't worked in a NICU that followed those guidelines I thought I'd reach out to see what everyone's thoughts were. 

 

 

 

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Of course! I have attached a publication of the work done at Southampton, which includes the nutritional assessment tool- I do not think there is anything there that would be too surprising, but it does mean that our late preterm/term infants do not get stuck on the same feed increases as ELBW, or really slow establishment of feeds. The nurses use this tool on Monday night shifts, ready for our nutrition ward round on Tuesday mornings. This specialist ward round comprises of Consultants, Neonatal pharmacist, Dietitian and surgical representatives. Hope it is helpful. 🙂 

My question back to the group: How do people feed babies (or not!)  with HIE undergoing Therapeutic Hypothermia.......???

 

image.png.46befe89509b95be7f3ca75679205527.png

Johnson_et_al-2015-nutritional screening tool.pdf

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On 4/10/2019 at 1:19 PM, peavyk said:

 I am on a committee for enteral feeds for ELBW infants.  I've pulled some recent literature to see what I could find and there are conflicting viewpoints on whether feeds should advance more slowly or faster in ELBW infants.  What is your guideline for enteral feeds progression in the ELBW infant?

 

Kärsten

 

 

I would recommend reaching out to Susan.Slattery@northwestern.edu who helped develop weight-based standardized feeding pathways with me when I was in Chicago.  The broad outlines of our approach were weight-based stratification, q12h advancement of volumes by nurses without waiting for the rounding team to arrive (in babies with expected course).  When I left that unit, I think we were advancing ELBWs ~24mL/kg/d after a few days of trophic feeds, but I heard through the grape vine that they either slowed that down for all ELBWs or subdivided the ELBWs around 600-700g and slowed down just the absolute smallest babies, but either way, she would have the most recent information.  Outcomes showing improvements in enteral nutrition without increased NEC were presented at PAS last year.

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