1. In this randomized controlled trial, the body-fat percentage among preterm infants was similar between those who received parenteral nutrition and those who received dextrose solution.

2. The time to full enteral feeding was similar between preterm infants who received smell and taste exposure before gastric-tube feeding versus those who did not.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Moderate-to-late-preterm infants, defined as infants born between 32 weeks zero days and 36 weeks six days gestation, are at increased risk for adverse health outcomes, including developmental delay, cardiometabolic disease, and death. Despite the need for adequate nutritional support following birth, pending sufficient intake of the mother’s breast milk, evidence to guide nutrition management in these infants is lacking. Other than stressing the importance of breast milk feeds, organizations such as the American Academy of Pediatrics and the National Perinatal Association do not provide clear guidelines on providing nutritional support. This trial investigated routine nutrition interventions to support moderate-to-late preterm infants and the effects of various strategies on body composition and time to full enteral feeding. Overall, the mean body-fat percentage among preterm infants at four months of corrected gestational age was similar between those who received parenteral nutrition and those who received dextrose solution. The body-fat percentage was also similar between infants who were given milk supplementation when maternal milk was insufficient and those who were exclusively fed with their mother’s breast milk without any supplementation. The study findings are not generalizable to late-preterm infants born after 35 weeks 6 days gestation and may be subject to bias due to the unblinded nature of the trial.

Click to read the study in NEJM

In-Depth [randomized controlled trial]: DIAMOND (Different Approaches to Moderate and Late Preterm Nutrition: Determinants of Feed Tolerance, Body Composition and Development) is a randomized controlled trial that investigated strategies to support nutritional management of moderate-to-late-preterm infants. Infants born between 32 weeks zero days and 35 weeks six days gestation were eligible for the trial if they had been admitted to a neonatal unit and their mothers intended to breastfeed. Infants were excluded if they had a known genetic abnormality impacting growth. Participants were randomly assigned in a 1:1 ratio to one of eight combinations consisting of three interventions: parenteral nutrition or intravenous dextrose, milk supplement or no supplement when the mother’s breast milk was insufficient, and exposure or no exposure to the taste and smell of milk before each tube feed. The primary outcome for the parenteral nutrition and milk supplementation interventions was the mean body fat percentage at four months of corrected gestational age. A total of 532 infants were enrolled in the trial, and those from ethnic and socioeconomic backgrounds associated with higher rates of preterm birth were well-represented. The mean body-fat percentage at four months among preterm infants was 26.0±5.4% in the parenteral nutrition group and 26.2±5.2% in the dextrose solution group (adjusted mean difference, -0.20; 95% confidence interval [CI], -1.32 to 0.92; p=0.72). The mean body-fat percentage among the milk and no supplementation groups was 26.3±5.3% and 25.8±5.4%, respectively (adjusted mean difference, 0.65; 95% CI, -0.45 to 1.74; p=0.25). The time to full enteral feeding among the taste and smell exposure group and the no exposure group was 5.8±1.5 days and 5.7±1.9 days, respectively (adjusted hazard ratio, 0.95; 95% CI, 0.80 to 1.14; P=0.59). In summary, this trial of various approaches to nutritional support for moderate-to-late-preterm infants demonstrated no effects on body composition or the time to full enteral feeding at 4 months.

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