TIME TO FULL ENTERAL FEEDING AND PREDICTORS AMONG VERY LOW BIRTH WEIGHT NEONATES ADMITTED IN NEONATAL INTENSIVE CARE UNIT

Abstract

Background: Timely achievement of full enteral feeding is crucial for very low birth weight neonates to minimize short- and long-term complications. However, delays in achieving full enteral feeding are common, particularly in resource-limited settings. This study investigates the time to full enteral feeding and its predictors’ gestational age, birth weight, and clinical factors among very low birth weight neonates in southern Ethiopia to optimize feeding protocols, improve survival rates, and enhance the quality of life for affected infants. Objective: To assess the time to full enteral feeding and predictors among very low birth weight neonates admitted to the neonatal intensive care unit in Southern Ethiopia 2024. Methods: An institutional-based retrospective cohort study was conducted among 328 very low birth weight neonates admitted to the Neonatal Intensive Care Units of selected public hospitals in Southern Ethiopia from July 1, 2021, to June 30, 2024. A simple random sampling method was applied to choose the study participants. The collected data was coded, entered, and cleaned in Epi data version 4.6 and was exported to STATA version 17 for analysis. Descriptive statistics were used to summarize the participants’ characteristics. The Kaplan-Meier survival curve was computed to estimate the median time to full enteral feeding and survival function. The log-rank test was used to assess differences among groups. Proportional hazard assumptions were verified both globally and with the Schoenfeld residual test. The model’s fit was evaluated using the Cox-Snell residual test. Variables having a p value <0.25 in the bivariate Cox proportional hazard model were fitted to multivariable analysis. An adjusted hazard ratio (AHR) with a 95% confidence interval (CI) was computed to report the strength of association, and variables having a p-value <0.05 at the 95% confidence interval were considered statistically significant predictor variables. Results: The median time to full enteral feeding was18 days (95% CI: 17-19). Very low birth weight neonates initiated kangaroo mother care (AHR: 2.9, CI: 1.53, 5.34), without necrotizing enterocolitis (AHR: 2.81, CI: 1.12, 7.03), with a single birth outcome (AHR: 1.96, CI: 1.13, 3.38), APGAR scores in the normal range (AHR: 2.08, CI: 1.31, 3.31), and hospital acquired infection (AHR: 1.74, CI: 1.17, 2.57) were statistically significant variables with time to full enteral feeding. Conclusion: This study found that the median time to full enteral feeding (FEF) in very low birth weight (VLBW) neonates exceeded the guideline recommendation. Receiving kangaroo mother care, having neonates without necrotizing enterocolitis, without hospital-acquired infection, with normal range APGAR scores, and single-tone birth outcomes were positively significant predictors for the time to achieve full enteral feeding among very low birth weight neonates. Healthcare providers should give special emphasis and close follow-up to very low birth weight neonates.