1. In this randomized controlled trial, the percentage of body fat in preterm infants who received enteral nutrition was similar to that of infants who received glucose solution.
2. Time to full enteral feeding was similar in preterm infants who were exposed to olfactory and gustatory cues before gastric feeding compared with those who were not.
Level of evidence: 1 (Excellent)
Research Summary: Moderate-to-late preterm infants, defined as infants born between 32 weeks 0 and 36 weeks 6 days of gestation, are at increased risk for poor health outcomes, including developmental delay, cardiometabolic disease, and death. After birth, adequate nutritional supplementation is required until adequate breastfeeding, but evidence is lacking to guide the nutritional management of these infants. Organizations such as the American Academy of Pediatrics and the National Perinatal Association have not provided clear guidelines for providing nutritional supplementation beyond emphasizing the importance of breastfeeding. This study investigated routine nutritional interventions to support moderate-to-late preterm infants and the effects of different strategies on body composition and time to exclusive enteral feeding. Overall, the mean percentage of body fat in preterm infants at 4 months corrected gestational age was similar in infants who received enteral feeding and those who received glucose solution. The percentage of body fat was also similar in infants who were supplemented with formula when breast milk was insufficient and those who were exclusively breastfed without supplementation. The findings of this study cannot be generalized to late preterm infants born after 35 weeks 6 days of gestation and may be biased because the study was unblinded.
Click here to read the NEJM study
detail [randomized controlled trial]: DIAMOND (Different Approaches to Nutrition of Moderate and Late Preterm Infants: Determinants of Feeding Tolerance, Body Composition and Growth) is a randomized controlled trial investigating strategies to support the nutritional management of moderate to late preterm infants. Infants born between 32 weeks 0 days and 35 weeks 6 days of gestation were included in the study if they were admitted to the neonatal unit and their mothers intended to breastfeed. Infants with known genetic abnormalities that affect growth were excluded. Participants were randomly assigned in a 1:1 ratio to one of eight combinations of three interventions: parenteral nutrition or intravenous glucose, milk supplementation or no supplementation if the mother had insufficient breast milk, and exposure to the taste and smell of milk before each tube feeding. The primary outcome of the parenteral nutrition and milk supplementation interventions was mean body fat percentage at 4 months corrected gestational age. A total of 532 infants were included in the study, with adequate representation of infants from ethnic and socioeconomic backgrounds with a high preterm birth rate.At 4 months, the mean percent body fat in preterm infants was 26.0 ± 5.4% in the enteral-feeding group and 26.2 ± 5.2% in the dextrose solution group (adjusted mean difference, -0.20; 95% confidence interval (CI) 0.01–0.95). [CI]-1.32 to 0.92, p=0.72). Mean body fat percentage in the milk-supplemented and unsupplemented groups was 26.3 ± 5.3% and 25.8 ± 5.4%, respectively (adjusted mean difference, 0.65; 95% CI, -0.45 to 1.74, p=0.25). Time to exclusive enteral feeding was 5.8 ± 1.5 days and 5.7 ± 1.9 days in the taste- and smell-exposed and unexposed groups, respectively (adjusted hazard ratio, 0.95; 95% CI, 0.80 to 1.14, p=0.59). In summary, this trial of different approaches to feeding moderate-to-late preterm infants showed no effect on body composition or time to exclusive enteral feeding at 4 months.
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