2 hourly versus 3 hourly feeding in premature infants: A randomised control trial

INTERVENTION: Premature infants will be given 3 hourly feeding 1. All infants will be given IV dextrose 10% or TPN at 65 to 80mls per kg per day at the first hour of life 2. Enteral feeding will be started before 96 hours of life 3. All infants will be fed with expressed breast milk 4. If mother's breast milk is insufficient preterm formula is added 5. Feeding will be started at 10 to 20mls pe r kg per day 6. Advancement of the feeding at 10 to 20mls per kg per day 7. All the infants will be fed via oral gastric tube 8. Oral gastric tube placement by staff nurse using pre established technique 9. Feeding will be given over 15 to 30 minutes with gravity depending on the volume of the milk 10. Gastric residual will be checked immediately before feeding unless requested by the managing team of not doing so. 11. If any clinical signs of enteral intolerance and/or severe medical instability were noted, then the feeding volume will be reduced or the feedings will temporarily withheld according to clinical routines. 12. TPN will be started at least before 24 hours of life, the volume is increase 15mls/kg/day to a target volume of 140 to 160 ml/kg/day 13. When enteral feedings reached 100mls/kg of the total target volume, TPN will be discontinued. 14. Pre feeding dextrostic will be monitore d every shift (8 hourly) for 48hour to observe episode of hypoglycaemia in the infants 15. Urine ketone also will be monitored every day for 48 hour once the IVD is off. CONDITION: Feeding premature infant PRIMARY OUTCOME: Day of achieving full feeding Day of regaining the birth weight SECONDARY OUTCOME: Secondary outcome 1: Episode of hypoglycaemia after achieving full feeding and TPN discontinued INCLUSION CRITERIA: Premature infants of 34 weeks gestation and below The birth weight of 1000gram to 1800gram