Randomised trial of continuous nasogastic , bolus nasogastric , and transpyloric feeding in infants

Forty three infants under 1400 g were fed by a bolus nasogastric, continuous nasogastric, or transpyloric route. There were more complications with transpyloric feeding and no identifiable benefits in the growth rate, oral energy input, or chosen biochemical indices of nutrition. Bolus or continuous nasogastric feeds rather than transpyloric are better routine methods in infants of low birth weight. Feeding tiny preterm infants is vitally important and yet may be very difficult. Transpyloric feeding has been used widely in the past. However, different comparisons with nasogastric feeding have produced conflicting results.`3 This study compares the growth of babies randomised to receive one of three methods of feeding: hourly bolus nasogastric feeding (bNG), continuous nasogastric feeding (cNG) and continuous transpyloric feeding (TP). Department of Neonatal Paediatrics, Glasgow Royal Maternity Hospital P D Macdonald C H Skeoch L G Alroomi P Galea Department of Biochemistry, Glasgow Royal Maternity Hospital H Carse F Dryburgh Department of Statistics and Modelling Science, University of Strathclyde G Gettinby Correspondence to: Dr C H Skeoch, Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ. Accepted 30 October 1991 Patients and methods A one year prospective study (January to December 1987) enrolled 43 infants of birth weight under 1400 g. The babies initially received total parenteral nutrition. On day 2 the feeding route was determined for each baby by opening a sealed envelope, and milk feeding started with 1 ml/hour of SMA low birthweight formula (Wyeth). Milk feeds were increased by increments of 0-5 to 1-0 ml/hour and supplemented with parenteral nutrition until such time as the infants were tolerating full energy and fluid requirements given as the low birthweight formula at 150 ml/kg a day. The position of the nasogastric tubes was confirmed by aspiration and pH testing. Transpyloric tubes were sited in the second and third part of the duodenum and the position was confirmed radiologically. The infants were fed by the selected method until they reached a weight of 1600 g after which they all received bolus nasogastric feeding. No baby received energy supplements during the trial period. Infants who received expressed breast milk were excluded from the trial as were those with major congenital malformations, those who developed hydrocephalus, and those with intrauterine viral infections. Weekly anthropometric measurements of length (using the Pedobaby babymeter), weight, and occipitofrontal circumference were made. In addition triceps and quadriceps skinfold thicknesses