Incidence, Clinical Signs And Co-Morbidities Of Feeding Intolerance Among Preterm Infants Aged 28-34 Weeks Of Gestation In A Tertiary Care Hospital Of Western Nepal-A Prospective Observational Study

Introduction: Feeding intolerance is common among the preterm neonates and is associated with different co-morbidities like respiratory depression, respiratory distress syndrome, apnea, hyperbilirubinemia, and hypoxic ischemic encephalopathy.Aim: To find the incidence of feeding intolerance in preterm neonates from 28-34 weeks of gestation along with the clinical signs and morbidities associated with feeding intolerance.Materials and Methods: A prospective observational hospital based study was conducted in Neonatal Intensive Care Unit (NICU) and postnatal ward of Universal College of Medical Sciences, a tertiary care hospital situated in western Nepal for 12 months (June 2018 to May 2019). All admitted preterm neonates between 28 to 34 weeks of gestation were included in the study and were followed-up for any neonatal morbidities along with feeding intolerance. Feeding intolerance was defined when the newborn had vomiting and/or abdominal distension and/or increased gastric residual volume with normal disruption of feeding process. Babies with feeding intolerance were subjected to final analysis for clinical signs and co-morbidities.Results: Out of 490 admitted preterm babies (28-34 weeks), 11.02% (n=54) had feeding intolerance with 61.1% (n=33) babies in the very low birth weight group. The mean birth weights of the total enrolled babies (n=490) and feed intolerant (n=54) babies were 1550 gm and 1418 gm, respectively. Different morbidities associated with feeding intolerance were respiratory distress (25.9%), respiratory distress syndrome (22.2%), jaundice (16.7%), apnea (5.6%) and necrotising enterocolitis (3.7%). Among the total 37 preterm deaths, four babies were in the feeding intolerance group. Majority of all feed intolerant babies had vomiting (90.7%, n=49) followed by gastric residue (57.4%), abdominal distension (55.6%), and reduced or absent bowel sounds (7.4%), respectively. The incidence of feeding intolerance was increased in babies fed with formula feed (p=0.46) and when feeding was started <24 hours (p=0.22) but the results were statistically insignificant.Conclusion: The incidence of feeding intolerance was 11.02% in the preterm neonates (28-34 weeks) with high proportion in very low birth weight babies. Vomiting, gastric residue and abdominal distension were three important signs of feeding intolerance in newborns.