Higher- or Usual-Volume Feedings in Infants Born Very Preterm: A Randomized Clinical Trial

Objective: To determine whether higher-volume feedings improve postnatal growth among infants born very preterm. Study design: Randomized clinical trial with 1:1 parallel allocation conducted from January 2015 to June 2018 in a single academic medical center in the US. In total, 224 infants with a birth weight 1001-2500 g born at <32 weeks of gestation were randomized to higher-volume (180-200 mL/kg/d) or usual-volume (140-160 mL/kg/d) feedings after establishing full enteral feedings (≥120 mL/kg/d). The primary outcome was growth velocity (g/kg/d) from randomization to study completion at 36 weeks of postmenstrual age or hospital discharge if earlier. Results: Growth velocity increased among infants in the higher-volume group compared with the usual-volume group (mean [SD], 20.5 [4.5] vs 17.9 [4.5] g/kg/d; P < .001). At study completion, all measurements were higher among infants in the higher-volume group compared with the usual-volume group: weight (2365 [324] g, z score −0.60 [0.73] vs 2200 [308] g, z score −0.94 [0.71]; P < .001); head circumference (31.9 [1.3] cm, z score −0.30 [0.91] vs 31.4 [1.3] cm, z score −0.53 [0.84]; P = .01); length (44.9 [2.1] cm, z score −0.68 [0.88] vs 44.4 [2.0], z score −0.83 [0.84]; P = .04); and mid-arm circumference (8.8 [0.8] cm vs 8.4 [0.8] cm; P = .002). Bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, or other adverse outcomes did not differ between groups. Conclusions: In infants born very preterm weighing 1001-2500 g at birth, higher-volume feedings increased growth velocity, weight, head circumference, length, and mid-arm circumference compared with usual-volume feedings without adverse effects. Trial registration: ClinicalTrials.gov; NCT02377050.