Efficacy of breast milk gastric lavage in preterm neonates
Patel, A.B.; Shaikh, S.
Indian Pediatrics 44(3): 199-203
2007
ISSN/ISBN: 0019-6061 PMID: 17413195 Document Number: 607042
Objective: To evaluate the effects of gastric lavage with mother's milk starting 4 h after birth in hospitalized preterm neonates. Methods: A randomized controlled trial was conducted in the special care neonatal unit of Indira Gandhi Medical College, Nagpur, Maharashtra, India. Preterm infants with illness (respiratory distress syndrome, perinatal hypoxia, shock) were assigned to receive, in addition to parenteral fluids, either gastric lavage with mother's milk within 4 h of birth and subsequently every 3 h till tolerance of nutritive enteral feeds (intervention or BML group, n=40) or remain nil per orally till tolerance of nutritive enteral feeds (control or NPO group, n=40). The main outcome was the mean number of days of parenteral fluids till successful tolerance of nutritive enteral feeds. They were also evaluated for mean duration of hospital stay, development of new complications, and mortality. Result: The infants in the BML group were more sick than those in the NPO group at baseline, however the mean duration of exclusive parenteral fluid was significantly less in the BML group than in the NPO group (3.9+or-1.5 vs. 5.4+or-2.6 days, P=0.003). In the NPO group, 60% of the infants stayed longer than 3 weeks in the hospital as compared to only 30% in the BML group. The risk of developing of new complication after randomization was also significantly less in the BML group (RR, 0.61; 95% CI: 0.40-0.95; P=0.03). The incidence of sepsis was 44% less in the BML group than in the NPO group (30 vs. 55%; RR, 0.58; 95% CI: 0.35-0.97; P=0.02). Multivariate logistic regression analysis showed that being in the BML group, birth weight and absence of complication at the time of hospitalization were strong predictors of improved outcome. There was no difference in mortality between the 2 groups. Conclusion: Early exposure to even small amounts of mother's milk in sick preterm neonates significantly reduces the days on parenteral fluids, risk of sepsis and duration of hospital stay without any adverse effect.