Behavioral Stress Is Affected by the Mode of Tube Feeding in Very Low Birth Weight Infants

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To compare the effect of continuous versus bolus feeding on behavioral responses of stress in very low birth weight infants during early postnatal life.


In a randomized, controlled trial conducted at 3 neonatal units, 70 premature infants with gestational age 24 to 29 weeks and birth weight <1200 g were randomly assigned to 1 of 3 feeding methods: continuous nasogastric feeding, bolus nasogastric feeding, and bolus orogastric feeding. Behavioral responses were video recorded during feeding at 7 and 15 days of postnatal age and at 32 weeks of postmenstrual age. The odds ratio (OR) of manifest behavioral stress was calculated by means of logistic regression.


A significantly higher risk of a behavioral stress response in bolus-fed infants compared with continuous-fed infants at 15 days of age was observed, [adjusted OR=4.1 (95% confidence interval: 1.1-15.4)]. A similar difference was observed at 32 weeks of postmenstrual age [adjusted OR=4.2 (95% confidence interval: 1.0-17.8)]. In addition, bolus-fed infants showed statistically significant higher need of behavioral and physiologic stabilization during feeding.


This trial suggests that continuous feeding is associated with lower behavioral stress response as compared with bolus feeding among very low birth weight infants, in early postnatal life.

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