Opinions In Scottish Neonatal Units About Enteral Feeding Of Preterm Infants

Background: Enteral feeding of preterm and low birth weight infants is a contentious issue. There is uncertainty about the optimum approach. Concerns relate to the competing, serious potential risks of necrotising enterocolitis and catheter-related infection associated with different feeding methods. Evidence on which clinicians can base clinical practice is weak. Research studies have been small and results conflicting. Large randomised trials are needed. To ensure that trial interventions are relevant and acceptable to clinicians and that results are generalisable, it is important to be informed about ranges of opinion influencing current practice. Aim: To document current opinion and reported practice of neonatologists in Scotland with respect to enteral feeding of preterm and low birth weight infants. Methods: Senior clinicians from 15 Scottish neonatal units participated in a survey of opinions and policies about feeding of preterm (≤32 weeks) and low birth weight (≤ 1500g) babies. A single researcher using face-to-face interviews and semi-structured questionnaires conducted the survey. Results: 8(53%) units have written guidelines for initiation of feeds, 5(33%) for the rate of increase and 3(20%) for the discontinuation of feeds. All aim to introduce maternal breast milk on day 1 or 2 of life. None delay milk introduction for >48hours in the absence of specific contraindications. If breast milk is unavailable, 1(7%) unit uses donor milk, 6(40%) use preterm formula, 5(33%) term formula and 3(20%) hydrolysed protein formula. Preferred volumes for initiating feeds are variable, ranging from 0.5ml every 6–12 hours to 1ml/hour. Criteria for discontinuing feeds based on gastric aspirates are inconsistent between units. Gastric residual volumes considered “large” vary from ≥25% of the hourly feed volume to ≥2 hourly feed volumes. Decisions to withold feeds are made by a variety of staff in most units. One clinician indicated that consultants in that unit usually make such decisions, another that decisions are most often made by nurses. Conclusion: There is wide variation in opinion among neonatologists in Scotland and variable use of feeding guidelines. This probably reflects clinical uncertainty and is likely to lead to similar disparity in practice. Such differences may influence important outcomes such as necrotising enterocolitis and line- or parenteral nutrition-related complications. There is an urgent need for large, well-designed studies to define optimum feeding strategies.