M. van der Star et al. / Open Journal of Pediatrics 2 (2012) 214-218 217
of infants who experienced feeding intolerance, defined
as feeds held longer than 12 hours [15]. More recently,
Dsilna et al. found no difference in feeding intolerance
defined as the number of occasions the infant was
diagnosed with suspected necrotizing enterocolitis (Bell
Stage I) followed by interruption of enteral feeds for at
least 8 hours [8]. A meta-analysis could not be performed
because modes of measuring feeding intolerance were
not comparable. Schanler reported that infants fed by the
continuous feeding method gained weight slower than
infants fed by the intermittent bolus feeding method [13].
Toce, however, did not find a difference in weight gain
(grams per kg per day) between the two groups [14].
Similarly, Macdonald et al. and also Silvestre et al. both
found no difference in weight gain (grams per week)
between the two groups [11,16].
The most recent Cochrane analysis reported that
overall, the seven included trials, involving 511 infants
of less than 1500 grams, found no differences between
the two feeding methods in time to achieve full enteral
feeds [12].
In the subgroup analysis of those studies comparing
continuous versus intermittent bolus nasogastric milk
feedings, the findings remained unchanged. There was
no significant difference in somatic growth and incidence
of NEC between the two feeding methods. One study
noted a trend toward more apneas during the study
period in infants fed by the continuous tube feeding
method compared to those fed by intermittent feedings
delivered predominantly by orogastric tube placements.
In subgroup analysis based on weight groups, one study
suggested that infants less than 1000 grams, and 1000 -
1250 grams birth weight, gained weight faster when fed
by the continuous nasogastric tube feeding method com-
pared to intermittent nasogastric tube feeding. A trend
was observed toward earlier discharge for infants less
than 1000 grams birth weight fed by the continuous tube
feeding method compared to intermittent nasogastric tube
feeding.
In conclusion, in line with other studies, we found no
differences in either weight gain, time to achieve full oral
feedings, or number of incidents between premature
babies fed by either continuous or bolus nasogastric tube
feeding methods.
5. ACKNOWLEDGEMENTS
The authors greatly acknowledg e th e ea rlier con tributions of doctors M.
Molenschot, I. Zonnenberg and M. de Vries, residents at the time, to
the preparation and performance of this study.
REFERENCES
[1] Aynsley-Green, A., Adrian, T.E. and Bloom, S.R. (1982)
Feeding and the development of enteroinsular hormone
secretion in the preterm infant: Effects of continuous gas-
tric infusions of human milk compared with intermittent
boluses. Acta Paediatrica, 71, 379-383.
doi:10.1111/j.1651-2227.1982.tb09438.x
[2] Lucas, A., Bloom, S.R. and Aynsley -Green, A. (1980) The
development of gut hormone response to feeding in neo-
nates. Archives of Disease in Childhood, 55, 678-682.
doi:10.1136/adc.55.9.678
[3] Lucas, A., Bloom, S.R. and Ay nsley-Green, A. (1986) Gut
hormones in “minimal enteral feeding”. Acta Paediatrica,
75, 719-723. doi:10.1111/j.1651-2227.1986.tb10280.x
[4] Blondheim, O., Abbasi, S., Fox, W.W. and Bhutani, V.K.
(1993) Effect of enteral gavage feeding rate on pulmo-
nary functions of very low birth weight infants. The
Journal of Pediatrics, 122, 751-755.
doi:10.1016/S0022-3476(06)80021-1
[5] Grant, J. and Denne, S.C. (1991) Effect of intermittent
versus continuous enteral feeding on energy expenditure
in premature infants. The Journal of Pediatrics, 118, 928-
932. doi:10.1016/S0022-3476(05)82213-9
[6] De Ville, K., Knapp, E., Al-Tawil, Y. and Berseth, C.L.
(1998) Slow infusion feedings enhance duodenal motor
responses and gastric emptying in preterm infants. The
American Journal of Clinical Nutrition, 68, 103-108.
[7] Dollberg, S., Kuint, J., Mazkereth, R. and Mimouni, F.B.
(2000) Feeding tolerance in preterm infants: Randomized
trial of bolus and continuous feeding. Journal of the
American College Nutrition, 19, 797-800.
[8] Dsilna, A., Christensson, K., Alfredsson, L., Lagercrantz,
H. and Blennow, M. (2005) Continuous feeding promotes
gastrointestinal tolerance and growth in very low birth
weight infants. The Journal of Pediatrics, 147, 43-49.
doi:10.1016/j.jpeds.2005.03.003
[9] Jawaheer, G., Shaw, N.J. and Pierro, A. (2001) Continu-
ous enteral feeding impairs gallbladder emptying in in-
fants. The Journal of Pediatrics, 138, 822-825.
doi:10.1067/mpd.2001.114019
[10] Lane, A.J.P., Coombs, R.C., Evans, D.H. and Levin, R.J.
(1998) Effect of feed interval and feed type on splanchnic
haemodynamics. Archives of Disease in Childhood (Fetal
and Neonatal Edition), 79, F49-F53.
doi:10.1136/fn.79.1.F49
[11] Macdonald, P.D., Skeoch, C.H., Carse, H., Dryburgh, F.,
Alroomi, L.G., Galea, P. and Gettinby, G. (1992) Ran-
domized trial of continuous nasogastric, and transpyloric
feeding in infants of birth weight under 1400 g. Archives
of Disease in Childhood, 67, 429-431.
doi:10.1136/adc.67.4_Spec_No.429
[12] Premji, S. and Chessell, L. (2007) Continuous nasogastric
milk feeding versus intermittent bolus milk feeding for
premature infants less than 1500 grams (review). The
Cochrane Collaboration, John Wiley and Sons Ltd., Ho-
boken, 1-27. www.thecochranelibrary.com
[13] Schanler, R.J., Shulman, R.J., Lau, C., Smith, E.O. and
Heitkemper, M.M. (1999) Feeding strategies for prema-
ture infants: Randomized trial of gastrointestinal priming
and tube-feeding method. Pediatrics, 103, 434-439.
doi:10.1542/peds.103.2.434
Copyright © 2012 SciRes. OPEN ACCESS