Ad libitum or demand/semi-demand feeding versus scheduled interval feeding for preterm infants

  • Review
  • Intervention

Authors

  • Karen Tosh,

    1. University Of St Andrews, Centre For Public Policy and Management, Fife, Scotland, UK
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  • William McGuire

    Corresponding author
    1. Australian National University Medical School, Department of Paediatrics and Child Health, Canberra, ACT 2606, Australia
    • William McGuire, Department of Paediatrics and Child Health, Australian National University Medical School, Canberra Hospital Campus, Canberra, ACT 2606, Australia. william.mcguire@act.gov.au.

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Abstract

Background

Feeding preterm infants in response to their hunger and satiation cues (ad libitum or demand/semi demand) rather than at scheduled intervals might help in the establishment of independent oral feeding, increase nutrient intake and growth rates, and allow earlier hospital discharge.

Objectives

To assess the effect of a policy of feeding preterm infants on an ad libitum or demand/semi-demand basis versus feeding prescribed volumes at scheduled intervals on growth rates and the time to hospital discharge.

Search strategy

We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2006), MEDLINE (1966 - March 2006), EMBASE (1980 - March 2006), CINAHL (1982 - March 2006), conference proceedings, and previous reviews.

Selection criteria

Randomised or quasi-randomised controlled trials (including cluster randomised trials) that compared a policy of feeding preterm infants on an ad libitum or demand/semi-demand basis versus feeding at scheduled intervals.

Data collection and analysis

The standard methods of the Cochrane Neonatal Review Group with separate evaluation of trial quality and data extraction by two review authors. The primary outcomes of interest were growth rates and age at hospital discharge.

Main results

We found seven randomised controlled trials that compared ad libitum or demand/semi-demand regimes with scheduled interval regimes in preterm infants in the transition phase from intragastric tube to oral feeding. The trials were generally small and of variable methodological quality. The duration of the intervention and the duration of data collection and follow up in most of the trials is not likely to have allowed detection of measurable effects on growth. The single trial that assessed growth for longer than one week found that the rate of weight gain was lower in the ad libitum fed infants [mean difference -3.30 (95% confidence interval -6.2 to -0.4) grams per kilogram per day]. Two trials reported that feeding preterm infants using an ad libitum or demand/semi-demand feeding regime allowed earlier discharge from hospital, but the other trials did not confirm this finding. We were not able to undertake meta-analyses because of differences in study design and in the way the findings were reported.

Authors' conclusions

There are insufficient data at present to guide clinical practice. A large randomised controlled trial is needed to determine if ad libitum of demand/semi-demand feeding of preterm infants affects clinically important outcomes. This trial should focus on infants in the transition phase from intragastric tube to oral feeding and should be of sufficient duration to assess effects on growth and time to oral feeding and hospital discharge.

Plain language summary

Ad libitum or demand/semi-demand feeding versus scheduled interval feeding for preterm infants

There is currently insufficient evidence to determine whether feeding preterm infants in response to their own hunger cues is better than feeding set volumes of milk at pre-defined intervals. We identified seven small trials that examined this issue, but in general these were methodologically flawed and did not report on important clinical outcomes. Further randomised controlled trials are needed to address this question.