Rigid feeding methods.

In the past 50 years, only 7 studies evaluating demand feedings in preterm infants have been published. The studies employed a variety of research methods including nonexperimental, quasi-experimental, and experimental designs. The earliest demand feeding studies are difficult to interpret due to inadequate sample sizes and incomplete descriptions of methodology. Trials in the 1980s and early 1990s were better described; however, they suffered from designs that produced findings that likely were strongly related to unit, nurse, or infant-specific interactions with the treatment, making it unlikely that findings could be replicated in other settings. The most recent studies are better conceived and described. Overall, the pattern of findings across the past 50 years indicates that preterm infants who were fed on demand showed some clinical improvement when compared to those infants offered other feeding patterns. Demand-fed infants exhibited more hunger cues and had improved behavior state organization, shorter duration of hospitalization, and gained weight at the same rate or faster than infants not fed on demand. Although each of the studies reviewed had some methodologic weaknesses, the consistency of findings across differing researchers, settings, empirical indicators, and years supports the cautious contention that demand feeding might prove to be the feeding approach of choice for most healthy preterm infants. Further studies in this area are warranted to add to current knowledge regarding the safety and efficacy of feeding various preterm infant populations. Research to address subpopulation differences (i.e., infants with congenital heart disease or orofacial lesions) in timing, method, and approaches to preterm infant feeding care is also needed.

Feeding Methods↗

PubMed2003

Refeeding syndrome: effective and safe treatment with Phosphates Polyfusor.

BACKGROUND: Severe hypophosphataemia associated with refeeding syndrome requires treatment with intravenous phosphate to prevent potentially life-threatening complications. However, evidence for replacement regimens is limited and current regimens are complex and replace phosphate inadequately. AIM: To assess the effectiveness and safety of 50 mmol intravenous phosphate infusion, given as a 'Phosphates Polyfusor', for the treatment of severe hypophosphataemia in refeeding syndrome. METHODS: Patients with refeeding syndrome and normal renal function received a Phosphates Polyfusor infusion for the treatment of severe hypophosphataemia (< 0.50 mmol/L). The outcome measures were serial serum phosphate, creatinine and calcium concentrations for 4 days following phosphate infusion and adverse events. RESULTS: Over 2 years, 30 patients were treated. Following treatment, 37% of cases had a normal serum phosphate concentration and 73% had a serum phosphate concentration of > 0.5 mmol/L within 24 h. Ten patients required more than one Phosphates Polyfusor infusion. Within 72 h, 93% of cases had achieved a serum phosphate concentration of > or = 0.50 mmol/L. No patient developed renal failure. Three episodes of transient mild hyperphosphataemia were recorded. Four patients developed mild hypocalcaemia. CONCLUSIONS: This is the largest published series of the use of intravenous phosphate for the treatment of severe hypophosphataemia (< 0.50 mmol/L), and is the most effective regimen described. All patients had refeeding syndrome and were managed on general wards.

Feeding Methods↗