Southampton expert says earlier milk feeding can boost health of premature babies

Baby in incubator

A leading neonatal expert based at Southampton’s teaching hospitals says earlier introduction of milk feeds for premature babies can improve their health and weight and reduce time spent in intensive care.

Dr Alison Leaf, a consultant neonatologist at the Princess Anne Hospital, spoke out following the publication of her research into whether or not earlier feeding can increase the risk of serious bowel complications if started within two days of birth.

Babies who are both pre-term and underweight are vulnerable to severe health problems including necrotising enterocolitis (NEC), a potentially fatal inflammation of the gut tissue, which most commonly occurs in babies receiving milk feeds.

As a result, doctors and nurses have regularly delayed the introduction of milk into feeding programmes in favour of a longer period spent on intravenous (drip) nutrition.

But the Abnormal Doppler Enteral Prescription Trial (ADEPT) study, co-ordinated by the National Perinatal Epidemiology Unit at the University of Oxford and funded by charity Action Medical Research, found that babies actually benefited from starting milk feeds early - within the first 24 to 48 hours after birth alongside intravenous nutrition, rather than waiting until day five or six to start milk.

“Good nutrition and growth is very important, however, these babies’ body organs, including the bowel, are immature – they are a challenge to feed,” said Dr Leaf, who led the project with Professor Peter Brocklehurst, director of the institute for women’s health at University College London.

“They often do not cope well with milk and may develop necrotising enterocolitis, which can make them very ill. Because of this, starting milk feeds is often delayed and early nutrition is given intravenously, but this also has risks, particularly of infection and inflammation in the liver.”

More than 400 premature babies from 54 hospitals across the UK and Ireland were involved in the study – the largest to date looking at the issue of feeding these high-risk premature babies – with half starting milk feeds on day two after birth and the other half on day six.

The results, published in journal Pediatrics, showed those who were introduced to milk feeds early achieved full milk feeding and came off intravenous nutrition an average of three days earlier than those on late feeds with no difference in the number experiencing serious bowel problems, including NEC.

Dr Leaf, who is also a senior researcher at the National Institute for Health Research Southampton Biomedical Research Centre, added: “Although three days might not seem much, it has a significant impact as babies on intravenous nutrition require high-dependency care and have to be looked after in specialist neonatal intensive care units, placing further strain on parents and hospital resources.

“We are confident the findings from this study can – and should – be put into effect immediately and will result in clearer guidelines on nutrition and feeding that can be used in neonatal units across the NHS to the benefit of premature babies and their families.”

More than 60,000 babies are born prematurely in the UK every year and one in ten born in the UK require some form of special care as a result of a difficult birth, a life-threatening condition or because they were born too early.

Dr Caroline Johnston, research evaluation manager at Action Medical Research, 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.”

Posted on Tuesday 10 April 2012