Abstract

Background: Optimal nutrition is critical for premature newborns' growth and survival, and delays in starting enteral feeding are linked to complications and death. Despite a high rate of preterm birth and mortality, little has been searched and limited data is available concerning the time to initiation of trophic feeding in preterms in Ethiopia. Therefore, this study will determine the time to initiation of trophic feeding and the predictors in the NICU of Adare General Hospital.

Method: A facility-based retrospective follow-up study was done among 291 preterm neonates selected using systematic random sampling from the preterms admitted to AGH from January 2021-December 2023. Data was extracted using data extraction checklist using Kobo Toolbox and then exported to Stata (version 16) for analysis. The incidence density was measured in person-hour observations. Kaplan-Meier survival curve and the log-rank test were used to estimate the survival time and compare survival curves respectively. Bi-variable Cox-regression was computed for each variable and a P-value of <0.2 was used as cut-off point to enter variables to multi-variable Cox-regression. Result of the final model is expressed in terms of AHR with 95% Confidence intervals.

Result: From the total of 291 preterm neonates followed 232 (79.7%) started trophic feeding. The overall incidence rate was 2.2 per 100 person hour observations and the median time to initiate trophic feeding was 34.8 (IQR: 2.5-67.6) hours. Having a birth weight of less <1500 grams (AHR: 0.48, 95% CI: 0.34, 0.69), a first minute APGAR of ≥ 7 (AHR: 2.66, 95% CI: 1.83, 3.87), having no hemodynamic instability (AHR: 2.08, 95% CI: 1.43, 3.03), no CPAP therapy (AHR: 3.82, 95% CI: 2.44, 5.99), and being born to a non PROM mother (AHR: 1.59, 95% CI: 1.08, 2.36) were found to be significant predictors of the time to initiate trophic feeding.

Conclusion: There was a significant delay in the initiation of trophic feeding in the study hospital. Birth weight, first minute APGAR, hemodynamic instability, CPAP and PROM were significant predictors. Therefore, it is recommended to implement a uniform standardized premature neonate feeding guideline and work on the improvement of the identified predictors.

Keywords: Trophic feeding, Preterm neonate, Time to initiate, Predictors

Dr. Sosena Asrat Abebe