Premature baby care: breakthrough discovery on feeding vulnerable newborn babies
This research was completed on 31 December 2009
Published on 26 June 2012
A nationwide team of researchers, led by Dr Alison Leaf and Professor Peter Brocklehurst, has provided much-needed evidence on how to nourish some of our most vulnerable newborn babies – premature babies born small for their age after a complicated pregnancy. Findings suggest starting milk feeds early, within 48 hours of birth, is better than delaying milk feeds and nourishing babies intravenously. This breakthrough discovery could prompt new guidelines on caring for high-risk newborn babies in hospitals worldwide.
What is the problem and who does it affect?
Before this landmark study, it had long been unclear how best to feed and nourish premature babies born small for their age because they didn’t grow properly during pregnancy (a problem known as growth restriction).
‘These very small premature babies have always been a challenge to feed,’ says Dr Leaf. ‘The babies’ body organs are immature and they are at risk of developing a serious bowel condition called necrotising enterocolitis (NEC), which can make them very ill.’
Sadly, NEC puts babies' lives at risk and those who survive can develop further health problems.1,2 They may need emergency surgery to remove damaged parts of the bowel and may develop infections, liver damage, and long-term hearing, vision and movement problems.
‘Because of concerns that starting milk feeds early might increase the risk of NEC, milk feeds have often been delayed and early nutrition has been given intravenously,’ continues Dr Leaf. ‘But the evidence base to support this practice was weak. What’s more, intravenous feeding brings its own risks, particularly of serious infections and liver disease. Before our study, it was far from clear how best to feed these high-risk babies.’
What did the project achieve?
Four hundred and four babies born at least five weeks early with growth restriction took part in a clinical trial. Half started milk feeds within 48 hours of birth; the others were nourished entirely intravenously at first and didn’t start milk feeds until between five and six days after birth.
‘Results show that introducing milk feeds sooner, rather than later, is better for these high-risk babies,’ explains Professor Brocklehurst. ‘Babies given the early milk feeds stopped needing an intravenous drip to supplement their feeds three days earlier, on average, than the other babies, and the length of time they stayed in high-dependency cots was shorter. Importantly, early milk feeds did not put babies at increased risk of developing NEC.’
These findings could quickly benefit babies by leading to new guidelines in hospitals across the UK and indeed worldwide.
What are the researchers’ credentials?
This trial, the largest to date looking at the issue of feeding these high-risk premature babies, was coordinated by Professor Peter Brocklehurst, of the University of Oxford,* and Dr Alison Leaf, of Southmead Hospital,** Bristol, and carried out by expert teams at 54 hospitals across the UK and Ireland.
|Project Leader||1. Professor Peter Brocklehurst FRCOG MSc FFPH|
|Location||1. National Perinatal Epidemiology Unit, University of Oxford *|
|Grant awarded||29 October 2004|
|Start date||6 June 2005|
|End date||31 December 2009|
|Acknowledgements||This project was supported by a generous grant from The Garfield Weston Foundation|
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*Professor Brocklehurst now directs the Institute for Women’s Health, University College London.
**Dr Leaf is now based at the National Institute for Health Research Biomedical Research Centre for Nutrition, Diet and Lifestyle at University Hospital Southampton NHS Foundation Trust and the University of Southampton.
***Dr Dorling is now based at Nottingham University Hospitals NHS Trust
****Dr Kempley is now based at Centre for Paediatrics, Barts and The London School of Medicine and Dentistry.