Comparison of Behavior-based and Volume-based Feeding Methods on Blood Glucose Levels and Weight Gain in Premature Infants

Background: This study was designed to compare blood glucose levels and weight gain in premature infants fed using cue-based feeding versus traditional volume-based feeding. Cue-based feeding relies on infants' behavioral cues, but concerns about hypoglycemia and the infant's inability to wake for feeding present challenges to its implementation. Methods: This was a single-blind, randomized controlled clinical trial (IRCT: IRCT۲۰۲۴۰۹۱۹۰۶۳۰۹۸N۱) of ۱۲۲ preterm infants allocated ۱:۱ to cue-based or volume-based feeding; caregivers could not be blinded, while assessors remained blinded. The primary outcome was weight trajectory (Day ۱–۳, Week ۱, discharge). Secondary outcomes included preprandial glucose levels, caregiver-initiated wake-ups, feeding adverse events, length of stay, and postmenstrual age at discharge. Analysis was by intention-to-treat using mixed-effects models adjusted for admission weight and baseline feeding method. Results: All ۱۲۲ infants were analyzed. Cue-based feeding increased early weight gain: Day ۱ +۲۴۸ g (۹۵% CI ۱۲۰–۳۷۶; P = ۰.۰۰۹), Day ۲ +۲۴۰ g (۹۵% CI ۹۶–۳۸۴; P = ۰.۰۱۵); later differences were not significant. Glucose remained >۶۰ mg/dL with no between-group effects or episodes of hypoglycemia. Wake-ups were significantly higher in the cue-based group (IRR ۲.۰۵, ۹۵% CI ۱.۶۵–۲.۵۵; P < ۰.۰۰۱). Adverse events were infrequent and similar between groups. Length of stay did not differ significantly between groups (۱۲ vs. ۱۳ days, P = ۰.۲۱۷); postmenstrual age at discharge was comparable. Conclusion: Cue-based feeding was associated with greater weight gain in the initial two days without compromising blood glucose levels. Further multicenter studies with larger sample sizes are recommended to validate these findings.

کلیدواژه ها:

Enteral Nutrition ، hypoglycemia ، Neonatal intensive care units (NICUs) ، oral feeding ، Weight gain