Trophic feeding initiation and its predictors in preterm neonates admitted to Neonatal Intensive Care Units: Multicenter study, Addis Ababa

Background: Delayed trophic feeding initiation is a significant risk for physical and neurological complications in neonates; however, data on feeding initiation in the current study setting are limited. Objective: This study aimed to determine the time to initiation of trophic feeding and to identify reasons for delayed initiation among preterm neonates. Methods: A prospective cohort study was conducted among 153 neonates admitted to Neonatal Intensive Care Units from February to April 20, 2023. Data were collected via Kobo and analyzed with STATA. Kaplan–Meier survival curves and Cox proportional hazards models were used for analysis. Primary and secondary outcomes: Median time and rate of trophic feeding initiation were estimated using Kaplan–Meier and simple frequency statistics, respectively, and adjusted hazard ratio with 95% confidence interval was used to identify factors for delayed initiation. Results: Among 153 neonates followed for 6853 person-hours, 85% initiated trophic feeding. The incidence rate of trophic feeding initiating was 1.9/100 person-hours with a median time of 41 h (95% confidence interval: 31–45). Delayed initiation was significantly associated with gestational age <34 weeks (adjusted hazard ratio: 0.54, 95% confidence interval: 0.37–0.79), first min APGAR score <7 (adjusted hazard ratio: 0.4, 95% confidence interval: 0.25–0.65), fifth min APGAR score <7 (adjusted hazard ratio: 0.51, 95% confidence interval: 0.34–0.79), small for gestational age (adjusted hazard ratio: 0.54, 95% confidence interval: 0.33–0.88), cesarean delivery (adjusted hazard ratio: 0.47, 95% confidence interval: 0.31–0.71), being out-born (adjusted hazard ratio: 0.50, 95% confidence interval: 0.30–0.83), respiratory distress syndrome (adjusted hazard ratio: 0.63, 95% confidence interval: 0.43–0.94), and hemodynamic instability (adjusted hazard ratio: 0.46, 95% confidence interval: 0.31–0.68). Conclusion: The study found a significant delay in trophic feeding initiation, despite guidelines recommending within 24 h. Gestational age <34 weeks, low APGAR scores, small for gestational age, cesarean delivery, being out-born, respiratory distress syndrome, and hemodynamic instability were associated factors. The authors emphasize the need for healthcare workers to begin trophic feeding within 24 h, regardless of these factors. They also recommend conducting larger studies nationwide to strengthen the evidence on this issue.