Impact of Breast Milk Gastric Lavage on Morbidity and Mortality in Preterm Neonates

Abstract

The preterm baby has very limited stored energy and needs an adequate supply of nutrient in order to survive beyond a few days. Nutrients can be provided either parenterally or enterally. Hospitalized preterm newborns otherwise on exclusive parenteral fluids were evaluated to see the impact of gastric lavage with breast milk on morbidity and mortality. This was a hospital
based randomized controlled trial. In addition to parenteral fluids, sick preterm babies were assigned to receive either gastric lavage with mother’s milk within 12 hours of birth and subsequently every 4 hours 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 = 42). The main outcome was the mean number of days till successful tolerance of nutritive enteral feeds and mean number of days to achieve full enteral nutrition. They were also evaluated for mean duration of hospital stay, development of new complications, and mortality. Despite sicker babies in the BML group at baseline, the mean number of days till successful tolerance of nutritive enteral feeds was significantly less (P <.001) in BML (4.68±1.38 days) as compared to NPO group (6.36± 1.43 days). The mean number of days to achieve full enteral feed were also minimum in BML group (9.53±2.77 days) as compared to (13.22±3.11days) NPO group. In the NPO group 73.8% of the babies stayed longer than 2 weeks in hospital compared to only 27.5% in the BML group. The risk of development of new complication specially septicemia after randomization was also significantly less in BML group [RR 1.68 (95% CI 1.01 -2.85) (P=0.042)]. There was no difference in mortality between 2 groups. Early exposure to
even small amounts of breast milk in sick preterm neonates significantly reduced the days to tolerate enteral feeds, risk of sepsis and the duration of hospital stay.