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Gastrointestinal problems in the Abnormal Doppler Enteral Prescription Trial (ADEPT Study)

Presented at the Neonatal Society 2010 Summer Meeting (programme).

Kempley S1, on behalf of the ADEPT Clinical Investigators Group2

1 Barts and the London School of Medicine and Dentistry, London, UK
2 NPEU, Oxford, UK

Background and Aims: Infants who had abnormal antenatal Doppler studies are at increased risk of developing necrotising enterocolitis (NEC) , with uncertainty regarding the optimum time to start enteral feeds. The ADEPT study has recently reported the results of a multicentre randomised trial comparing early and late enteral feeding in this patient group. In this sub-analysis we have examined the patterns of gastrointestinal symptoms in ADEPT study patients randomised to early and late feeding.

Methods: In 54 participating hospitals, 404 premature, small-for-gestational age infants with abnormal antenatal Doppler findings were randomised to early or late introduction of enteral feeding:

Early: commencing feeds at 24-48 hours
Late: commencing feeds at 120-144 hours

Informed parental consent was obtained for all patients; the study had full MREC approval. Primary study outcomes were time to reach full enteral feeds (sustained for 3 days) and incidence of NEC. All patients with gastrointestinal symptoms had a data form completed by local clinicians. These data have been analysed to determine the range of symptoms encountered in early and late feeding groups. Rates of NEC have been compared in those above and below 29 weeks gestation.

Results: As previously reported, patients randomised to early feeding achieved full enteral feeds more rapidly (18 vs 21 days) with no increase in the incidence of NEC. Although GI symptoms were seen slightly more often in patients randomised to early feeding, this excess was primarily due to an increase in reported dysmotility. There were no differences in rates of surgical intervention between the groups.

Table: Number of patients in each group developing gastrointestinal symptoms

Conclusion: Approximately a quarter of ADEPT patients developed gastrointestinal symptoms. A high incidence of NEC was found in babies <29 weeks gestation with abnormal antenatal Dopplers. The incidence of NEC was not influenced by the time of introduction of the first enteral feed.

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