PEARLS  259, May 2010, written by Brian R McAvoy

Clinical question
How effective is ad libitum or demand/semi-demand feeding for preterm infants in the transition phase from intragastric tube to oral feeding?  

Bottom line
Three trials reported that, compared with scheduled interval feeding, an ad libitum or demand/semi-demand feeding regimen for preterm infants allowed earlier attainment of full oral feeding and earlier hospital discharge (by about 2 to 4 days). Other trials did not confirm this finding.  

Caveat
The trials were generally small and of variable methodological quality. The duration of the intervention and the duration of data collection and follow-up in most of the trials were not likely to have allowed detection of measurable effects on growth.  

Context
Scheduled interval feeding of prescribed enteral volumes is current standard practice for preterm infants. Feeding preterm infants in response to their hunger and satiation cues (ad libitum or de-mand/semi demand) rather than at scheduled intervals might help in the establishment of independent oral feeding, increase nutrient intake and growth rates, and allow earlier hospital discharge.  

Cochrane Systematic Review
McCormick FM et al. Ad libitum or demand/semi-demand feeding versus scheduled interval feeding for preterm infants. Cochrane Reviews 2010, Issue 2. Article No. CD005255. DOI: 10.1002/14651858.CD005255.pub3. This review contains 8 studies involving 496 participants.