Enteral Feeding during Indomethacin and Ibuprofen Treatment of a Patent Ductus Arteriosus

Objective To test the hypothesis that infants who are just being introduced to enteral feedings will advance to full enteral nutrition at a faster rate if they receive trophic (15 mL/kg/d) enteral feedings while receiving indomethacin or ibuprofen treatment for patent ductus arteriosus. Study design Infants were eligible for the study if they were 23(1/7) -30(6/7) weeks' gestation, weighed 401-1250 g at birth, received maximum enteral volumes <= 60 mL/kg/d, and were about to be treated with indomethacin or ibuprofen. A standardized feeding advance regimen and guidelines for managing feeding intolerance were followed at each site (N = 13). Results Infants (N = 177, 26.3 +/- 1.9 weeks' mean +/- SD gestation) were randomized at 6.5 +/- 3.9 days to receive trophic feeds (feeding group, n = 81: indomethacin 80%, ibuprofen 20%) or no feeds (fasting [ nil per os] group, n = 96: indomethacin 75%, ibuprofen 25%) during the drug administration period. Maximum daily enteral volumes before study entry were 14 +/- 15 mL/kg/d. After drug treatment, infants randomized to the feeding arm required fewer days to reach the study's feeding volume end point (120 mL/kg/d). Although the enteral feeding end point was reached at an earlier postnatal age, the age at which central venous lines were removed did not differ between the 2 groups. There were no differences between the 2 groups in the incidence of infection, necrotizing enterocolitis, spontaneous intestinal perforation, or other neonatal morbidities. Conclusion Infants required less time to reach the feeding volume end point if they were given trophic enteral feedings when they received indomethacin or ibuprofen treatments.