ABSTRACT: Early discharge of stable preterm infants still requiring gavage feeds has the potential benefits of uniting families sooner and reducing health care and family costs compared to discharge home when on full sucking feeds. Potential disadvantages include the increased burden for the family and the possibility of complications related to gavage feeding.
To determine the effects of a policy of early discharge of stable preterm infants with home support of gavage feeding compared with a policy of discharge of such infants when they have reached full sucking feeds.
The standard search strategy of the Cochrane Neonatal Review Group was used together with additional searches of the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003), CINAHL (1982 to April week 1 2003), EMBASE (1980 to 2003 week 15) and MEDLINE (1966 to April week 1 2003).
All randomised and quasi-randomised trials among infants born <37 weeks and requiring no intravenous nutrition at the point of discharge were included. Trials were required to compare early discharge home with gavage feeds and health care support with later discharge home when full sucking feeds were attained.
Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information. Data analysis was done in accordance with the standards of the Cochrane Neonatal Review Group.
Data from one quasi-randomised trial, with 88 infants from 75 families, were included in the review. Infants in the early discharge program with home gavage feeding had a mean hospital stay that was 9.3 days shorter [MD -9.3 (-18.49 to -0.11)] than infants in the control group. Infants in the early discharge program also had a lower risk of clinical infection during the home gavage period compared with the corresponding time in hospital for the control group [RR 0.35 (0.17 to 0.69)]. There were no significant differences between groups in duration and extent of breast feeding, weight gain, re-admission within the first 12 months post discharge from the home gavage program or from hospital, scores reflecting parental satisfaction, or health service use.
Experimental evidence to evaluate the benefits and risks in preterm infants of early discharge from hospital with home gavage feeding compared with later discharge upon attainment of full sucking feeds is limited to the results of one small quasi-randomised controlled trial. High quality trials with concealed allocation, complete follow-up of all randomised infants and adequate sample size are needed before practice recommendations can be made.
Cochrane database of systematic reviews (Online) 02/2003; · 5.72 Impact Factor
ABSTRACT: Background - The importance of feeding infants breast milk is demonstrated in decreased rates of infection and improved development. We have little understanding of the pattern or rate of breastfeeding among infants who were born premature. Objective - To determine the pattern of feeding breast milk to infants born < 33 weeks gestation. Design - One hundred infants (from 87 mothers) were enrolled at the Women's and Children's Hospital within five days of commencing enteral feeds, 95 were followed to four months corrected age (CA). The duration and proportion of breastfeeding was categorised according to World Health Organisation criteria. Data were collected during hospitalisation, at infants estimated due date (EDD), and two and four months CA. Outcomes - Eighty of 100 infants received some breast milk, similar to the initiation rates of breastfeeding among term infants. At EDD (approx 10 weeks post birth), only 18/96 (19%) infants were fully breastfed, 62 (65%) received combinations feeds and 16 (17%) were formula fed. From a total of 95 infants remaining in the study, seven (7%) were fully breastfed and 16 (17%) were formula fed through to four months CA. By four months CA, the average duration of all breastfeeding was 11+/-5 weeks, (approximately one week old CA). Conclusions - The duration and extent of breastfeeding in preterm infants is less than that observed in term infants.
Asia Pacific Journal of Clinical Nutrition 01/2003; 12 Suppl:S43. · 1.13 Impact Factor
ABSTRACT: This study investigated the effect of lag times between blood sampling and glucose analysis on plasma glucose results from 6 volunteers. Our aim was to determine whether glucose tolerance test protocols should include instructions on the handling of blood between sampling and analysis. Plasma glucose levels remained stable for all lag times between spinning and analysis. With a lag time between blood sampling and spinning, plasma glucose levels did not remain stable, and a significant lowering of plasma glucose was found in the first 2 hours of lag. With increased lag time there was no further decrease in plasma glucose levels. Glucose tolerance test protocols should include clear guidelines on the handling of the blood samples between collection and analysis, and the spinning down of samples needs to be prioritized.
Australian and New Zealand Journal of Obstetrics and Gynaecology 09/1997; 37(3):286-8. · 1.24 Impact Factor