Clinical outcome of enteral nutrition versus IV fluids in newborns on inotropes: A randomized study

Benefits of early enteral nutrition in neonates are well established, but the effects of enteral nutrition in neonates with inotropic support for hemodynamic instability are not well studied. A study was planned to compare the clinical outcome in terms of morbidity, mortality, and hospital stay in the neonates with enteral feed versus intravenous (IV) fluid group with inotropes and to evaluate the safety of enteral nutrition in neonates with inotropic support as well as to determine the cutoff levels of the inotropes at which enteral feed is well tolerated. Methods: A randomized control trial was conducted in a tertiary care neonatal intensive care unit, Kanpur, and included 200 neonates on inotropes who were allotted randomly 100 each in enteral feed and IV fluid group. Results: Demographic characteristics were comparable in both the groups, mean gestational age being 36.09 +/- 0.4 weeks and 35.96 +/- 0.3 weeks, and mean weight on admission being 2321.60 +/- 73.9 g and 2214.30 +/- 53.1 g for the enteral feed group and IV fluid group, respectively. In enterally fed neonates, 88.3% were discharged and 11.7% were expired, while in the IV fluid group, 69.6% were discharged and 30.4% were expired. There was a significant difference in the mean duration of hospital stay (13.4 +/- 5.0 days and 15.5 +/- 5.1 days in enteral feed and IV fluid group, respectively). No complications were observed in 88.2% of enterally fed neonates versus 93.5% of neonates in the IV fluid group. There was no significant difference between complications in two groups (P = 0.245). When receiver operating characteristic(ROC) curve analysis was done to find out the cutoff level of inotropes to predict feed tolerance, at cutoff level of dopamine 10 mu/kg/min + dobutamine 7.5 mu/kg/min, the sensitivity and specificity to predict feed tolerance were found to be 61.5% and 77%, respectively.Conclusions: Enteral nutrition in neonates with inotropic support is associated with shorter duration of hospital stay and better survival rate. Neonates can tolerate enteral feed up to dopamine 10 mu/kg/min and dobutamine 7.5 mu/kg/min.