ELBW premies have extremely immature gastrointestinal function which often limits their enteral feeding. However, some degree of nutrient exposure is essential even to the immature gut to prevent intestinal mucosal atrophy. Trophic feeds (a.k.a. minimal enteral nutrition) consist of small volumes of nutrients administered enterally to "prime the gut" for later feeding. Trophic feeds are not designed to serve as a significant source of caloric or volume intake. Multiple studies have demonstrated beneficial effects of trophic feeds and no adverse consequences.

The definition of trophic feeds varies from 5 – 20 ml/kg/d. Extremely small amounts (1cc OG q6 – 8 hours) have been shown to improve GI hormonal and motor activity. Premature infants can receive trophic feeds as early as DOL#1 and ideally no later than DOL#3. Contraindications to trophic feeds include any reason for impaired GI mucosal blood flow (asphyxia, hypoxia, hypotension, PDA, Indocin administration, NEC, etc.)

The ideal substance to use for trophic feeds is colostrum/breast milk. At Vanderbilt, we typically give 5 – 10 ml/kg/d. Trophic feeds may be administered by continuous drip infusion or bolus gavage. Trophic feeds are kept at a constant volume each day until such time as the baby is deemed stable enough and ready to advance to enteral nutrition.

Of note, studies have shown that the incidence of NEC is not increased by providing small volume enteral feeds while a low-lying UAC is in place.

References:

Schanler RJ, et al. Feeding strategies for premature infants: randomized trial of gastrointestinal priming and tube-feeding method. Pediatrics 1999; 103: 434-9.

Troche B, et al. Early minimal feedings promote growth in critically ill premature infants. Biol Neonate 1995; 67: 172-181.

Tyson JE, Kennedy KA. Minimal enteral nutrition in parenterally fed neonates. Cochrane Systematic Reviews. http://www.nichd.nih.gov/cochrane/tyson/tyson.htm

Thureen PJ. Early Aggressive Nutrition in the Neonate. Pediatrics in Review 1999; 20: e45-e55. http://www.pedsinreview.org/cgi/content/full/20/9/e45

Davey AM, et al. Feeding premature infants while low umbilical artery catheters are in place: a prospective, randomized trial. J Pediatrics 1994; 124: 795-9.

Most recently discussed at Collaborative Pathways meeting 9/12/01.