Predictors of full enteral feeding achievement in very low birth weight infants

Abstract

The members of the "Emilia Romagna Perinatal Network" are: Stefania Alati, Neonatal Intensive Care Unit - Ospedale Maggiore - Bologna; Gina Ancora, Neonatal Intensive Care Unit - Rimini; Alberto Berardi, Neonatal Intensive Care Unit - Modena; Augusto Biasini, Neonatal Intensive Care Unit - Cesena; Luca Casadio, Neonatal Intensive Care Unit - Ravenna; Roksana Chakrokh, Neonatal Intensive Care Unit - Ospedale Maggiore - Bologna; Maria Contiero, Neonatal Intensive Care Unit - Ferrara; Claudio Gallo, Neonatal Intensive Care Unit - Modena; Giampaolo Garani, Neonatal Intensive Care Unit - Ferrara; Giancarlo Gargano, Neonatal Intensive Care Unit - Reggio Emilia; Chiara Locatelli, Neonatal Intensive Care Unit - Policlinico S.Orsola-Malpighi - Bologna; Cinzia Magnani, Neonatal Intensive Care Unit - Parma; Palma Maria Angela Mammoliti, Neonatal Intensive Care Unit - Rimini; Bruno Mordini, Neonatal Intensive Care Unit - Modena; Sabrina Moretti, Neonatal Intensive Care Unit - Parma; Claudia Muratori, Neonatal Intensive Care Unit - Ravenna; Simona Pedori, Neonatal Intensive Care Unit - Reggio Emilia; Francesca Piano, Neonatal Intensive Care Unit - Rimini; Giancarlo Piccinini, Neonatal Intensive Care Unit - Ravenna; Claudio Rota, Neonatal Intensive Care Unit - Reggio Emilia; Fabrizio Sandri, Neonatal Intensive Care Unit - Ospedale Maggiore - Bologna; Marcello Stella, Neonatal Intensive Care Unit - Cesena. Background: To elucidate the role of prenatal, neonatal and early postnatal variables in influencing the achievement of full enteral feeding (FEF) in very low birth weight (VLBW) infants and to determine whether neonatal intensive care units (NICUs) differ in this outcome. Methods: Population-based retrospective cohort study using data on 1,864 VLBW infants drawn from the "Emilia-Romagna Perinatal Network" Registry from 2004 to 2009. The outcome of interest was time to FEF achievement. Eleven prenatal, neonatal and early postnatal variables and the study NICUs were selected as potential predictors of time to FEF. Parametric survival analysis was used to model time to FEF as a function of the predictors. Marginal effects were used to obtain adjusted estimates of median time to FEF for specific subgroups of infants. Results: Lower gestational age, exclusive formula feeding, higher CRIB II score, maternal hypertension, cesarean delivery, SGA and PDA predicted delayed FEF. NICUs proved to be heterogeneous in terms of FEF achievement. Newborns with PDA had a 4.2 days longer predicted median time to FEF compared to those without PDA; newborns exclusively formula-fed had a 1.4 days longer time to FEF compared to those fed human milk. Conclusions: The results of our study suggest that time to FEF is influenced by clinical variables and NICU-specific practices. Knowledge of the variables associated with delayed/earlier FEF achievement could help in improving specific aspects of routine clinical management of VLBW infants and to reduce practice variability. © 2014 Corvaglia et al.