The way premature babies are fed in hospitals could be set to change following the results of a research programme – funded by children’s charity Action Medical Research*
High-risk premature babies are vulnerable to severe bowel problems, which has led previously to a tendency to delay the start of milk feeds. Babies who are born both premature and ‘growth-restricted’ would generally benefit from starting milk feeds within the first 24-48 hours after birth, the study found. Doctors and nurses can now be more confident in starting to feed these high-risk babies earlier.
The trial, the largest to date looking at the issue of feeding these high-risk premature babies, was co-ordinated by the National Perinatal Epidemiology Unit at the University of Oxford, and carried out at 54 hospitals across UK and Ireland.
The significant findings could also lead to babies being able to leave specialist care units earlier, freeing up vital high dependency care cots for other sick babies to use, the lead researchers have said.
Dr Alison Leaf, Consultant Neonatologist and Professor Peter Brocklehurst, from the National Perinatal Epidemiology Unit, University of Oxford, led the research study which looked at the feeding of babies born five or more weeks early, who were also smaller than they should have been for their age.
Dr Leaf, who is now an Academic Consultant at the National Institute for Health Research, Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust and the University of Southampton said: “These babies are a challenge to feed. Good nutrition and growth is very important, however their body organs, including the bowel, are immature. They often do not cope well with milk, and may develop severe bowel inflammation, a condition called necrotising enterocolitis (NEC), which can make them very ill.
“Because of this, starting milk feeds is often delayed and early nutrition is given intravenously. This also has risks, particularly of infection and liver inflammation. Until now, nobody had tested whether it is better to start milk feeds early or to delay, so the project was designed to answer this question,” she added.
More than 400 premature babies were involved in the study to assess whether they should be given milk feeds early, or later, in a bid to reduce risks to their health. Half the babies started milk feeds on day 2 after birth, and the other half on day 6 after birth.
Almost half of the babies in the trial required some respiratory support, though really sick babies were not included in the trial.
Full feeding was achieved earlier in the babies who started milk feeds on day 2. On average, these babies no longer needed an intravenous drip for feeds three days earlier than the babies starting milk feeds on day 6. There was no difference in the number of babies experiencing severe bowel problems, including NEC, between those who had early feeds and those who started later.
Over 60,000 babies are born prematurely every year in the UK and one in ten babies born in the UK need some form of special care at birth as a result of a difficult birth, a life-threatening condition or because they were born too early. Action Medical Research has a proud history of funding research that has benefited thousands of babies and their families.
Dr Caroline Johnston, Research Evaluation Manager, said: “This key research breakthrough funded by Action Medical Research will potentially lead to a change in clinical practice in neonatal intensive care throughout the UK and beyond. The charity finds and funds some of the best medical research in the world for the benefit of babies, children and young people and we are delighted to announce the publication of these exciting results.”
Professor Brocklehurst, who is now Director of the Institute for Women’s Health, University College, London, concluded: “Early feeding appears to be better for these high risk babies. This research will enable more high risk premature babies to be fed early, and to achieve full feeding earlier. This will reduce the need for intravenous drips and infusions.”
“It will also reduce the duration of occupancy of a high-dependency cot, which will free up resources for other sick babies, thus providing benefit for a wider population of sick infants,” he said.
The great majority of the babies received their mother’s breast milk when feeding was started, rather than donor breast milk or formula.
The research team are confident that the findings from this study can be put into effect immediately, and will result in clearer guidelines on nutrition and feeding. These guidelines can be used in neonatal units across the UK healthcare sector, and potentially worldwide, to the benefit of premature babies and their families.
In addition, this trial has laid the foundation for a programme of further research aimed at answering important questions about the best way to feed and nourish premature and vulnerable babies.
Visit action.org.uk for more information on Action Medical Research
*This project was supported by a generous grant from The Garfield Weston Foundation