Title: Spoon feeding results in early hospital discharge of low birth weight babies
Abstract: To evaluate the adequacy and feasibility of spoon feeding in terms of physical growth and transition to breast feeding in early hospital-discharged low birth weight (LBW) neonates. A trial with two independent randomized controlled trials (RCTs), which was conducted at the tertiary-level neonatal unit of a teaching hospital and included home-based treatment. Singleton live-born neonates with a gestational age of ⩾32 weeks, a birth weight of >1250 g and ⩽1600 g, and fulfilling the feeding criteria were included in the study. The study was conducted over an 18-month period with 79 and 65 subjects enrolled into two RCTs in a large trial. Weight gain pattern during the study period was the primary outcome variable, and the number of days required by the neonate for transition to breast feeding and feeding-associated morbidity were the secondary variables. In Trial I, babies were gradually transitioned from nasogastric (NG) feeding and spoon feeding to breast feeding in the hospital, whereas in Trial II, babies were transitioned from spoon feeding to breast feeding in the hospital and at home. Eligible neonates were randomized into one of the two groups in each of the two trials using a computer-generated random number sequence. Trial I consisted of NG feeding and spoon feeding groups, both in a hospital setup, whereas Trial II consisted of a spoon-feeding group in hospital and home setups. Baseline neonatal and maternal characteristics were comparable in both groups of each trial, including maternal medical and obstetrical morbidities. In Trial I, out of 79 babies enrolled, 72 babies (91.1%) completed the study, whereas in Trial II, 92.3% (60 babies out of 65 babies enrolled) neonates completed the trial. The mean (s.d.) weight gain in neonates during the study period in Trial I in a hospital setup was 4.72 (4.68) g kg−1 per day in the NG feeding group and 4.47 (3.14) g kg−1 per day in the spoon-feeding group (P=0.8836). Similarly, spoon-fed babies gained 7.06 (4.26) g kg−1 per day in the hospital group, whereas they gained 7.56 (3.31) g kg−1 per day in the home group (P=0.5984) during the study period of 28 days. After randomization, the time taken for transition to breast feeding was 12.31 (3.32) days and 14.39 (4.10) days (P=0.0201) in Trial I, whereas it was 3.55 days and 9.81 days (P=0.0000) in Trial II in the two groups, respectively. In Trial II, the mean (s.d.) duration of hospital stay was 14.58 (2.83) days in the hospital group and 10.19 (2.26) days in the home group (P=0.0000). Neonatal morbidity was comparable during the study period in the two groups in both trials. Use of supplementary spoon feeding is found to be adequate and feasible in terms of physical growth and transition to breast feeding in early hospital-discharged (home group) LBW babies.