Two-hourly vs Three-hourly Feeding in Very Low Birthweight Neonates: A Randomized Controlled Trial

Background There is no consensus regarding the feeding interval in very low birth weight (VLBW) babies. If 2-hourly feeding schedule is feasible without increasing harm to the neonate, the nursing time consumed in the feeding of VLBW babies can be reduced. Objective To study whether 3-hourly feeding is non-inferior to 2-hourly feeding with respect to time to reach full feeds in VLBW neonates. Design Open-label, randomized controlled trial. Subjects 350 Neonates weighing between 1000 to 1500 grams, in whom feed could be started within 96 hours of life randomized to either 2-hourly or 3-hourly feeding schedule. Primary outcome Time to achieve full enteral feed. Results The primary outcome of time to achieve full enteral feed was comparable in the two feeding schedule groups (median 5 days IQR 4–6 days in both groups; P =0.665). Among the secondary outcomes, there were no significant differences in incidence of hypoglycemia (RR 0.86; 95% CI: 0.29–2.5) feed intolerance (RR 1.08: 95%CI: 0.5–2.3), and necrotizing enterocolitis (RR 0.8; 95% CI: 0.22–2.3) in both the groups. Conclusion Three hourly feeding does not increase the risk of hypoglycemia, necrotizing enterocolitis or feed intolerance.