Feeding tolerance in preterm infants: randomized trial of bolus and continuous feeding.

OBJECTIVE To test the hypothesis that continuous gastric infusion (CGI) is better tolerated than intermittent gastric bolus (IGB) in small very low birth weight (VLBW) infants. DESIGN Two-center, prospective, randomized, unmasked clinical trial. PATIENTS 28 VLBW infants (birth weight <1250 g). A strict feeding protocol was followed. INTERVENTION Patients were randomized to IGB or CGI. MAIN OUTCOME MEASURES Time to reach full feeds (160 cc/kg/d)(by design and real), daily weight, caloric intake, residual gastric volume and type of feeding (formula vs. human milk vs. both). RESULTS Five infants failed to complete the study because of death (n = 4) or protocol violation (n = 1). The two groups did not differ by birth weight or gestational age; infants fed via IGB reached full feeds earlier (p = 0.03) and had less delay in reaching full feeds than infants fed via CGI. CONCLUSION Contrary to our hypothesis, gravity IGB is more effective than CGI in improving feeding tolerance in small VLBW infants.