ADEPT trial - early versus delayed enteral feeding for babies born with absent or reversed end-diastolic flow and growth restriction
A major area of uncertainty in the care of preterm babies is when to begin milk feeds. Beginning feeds early, within the first two days after birth, may have advantages for the baby's nutrition and growth, but may increase the incidence of serious gastrointestinal problems such as necrotising enterocolitis (NEC). Conversely, starting feeds late (on about day 5 after birth) may increase the risk of infections, as babies would then need to be fed intravenously for a prolonged period. Both early and late feeding regimens are in use in British hospitals.
In this study, babies who were preterm (less than 35 weeks), small for gestational age and had absent or reversed end diastolic flow on antenatal Doppler examination were randomised within the first 24 hours after birth to commence milk feeds on either day 2 (24-48 hours) or day 6 (120-144 hours) after birth. Feeds were increased according to a predefined schedule. Main outcomes were the time to establishment of full enteral feeds, NEC, death before discharge, infection and growth (weight and head circumference). The study completed recruitment of 404 babies at the end of May 2009, and the main trial results were published in Pediatrics in 2012.
- Leaf A, Dorling J, Kempley S, McCormick K, Mannix P, Brocklehurst P. ADEPT - Abnormal Doppler Enteral Prescription Trial. BMC Pediatr. 2009;9(1):63.
- Leaf A, Dorling J, Kempley S, McCormick K, Mannix P, Linsell L, Juszczak E, Brocklehurst P. Early or Delayed Enteral Feeding for Preterm Growth-Restricted Infants: A Randomized Trial. Pediatrics. 2012;129(5):e1260-8.
- Kempley S, Gupta N, Linsell L, Dorling J, McCormick K, Mannix P, Juszczak E, Brocklehurst P, Leaf A, ADEPT Trial Collaborative Group. Feeding infants below 29 weeks' gestation with abnormal antenatal Doppler: analysis from a randomised trial. . Arch dis Child Neonatal Ed. 2014;99(1):F6-F11.