Background: Globally, about 18 million infants are born with a birth weight of <2500 gm every year. Though these infants constitute only 14% of total live births, they account for 60-80 % of total neonatal deaths. Most of these deaths can be prevented with extra attention to warmth, prevention of infections & more importantly optimal feeding. What prompted us to do this study? Shortage of staff caused missed feeding, resulting in inadequate weight gain, even decrease in weight after initial increase. While infusion pumps were being used only for intra-venous drug infusions, we hypothesized that using them for gavage feeding could be advantageous. The concept of continuous intra-gastric infusion feeding dates back to 1972 [Valman- source Cochrane neonatal study group]. The research questions we sought to address were:

1. Whether continuous feeding of neonates can make any difference in different aspects of growth as compared to bolus feeding.
2. Can introduction of continuous enteral feeding by infusion pump decrease human errors, be cost effective, and overall be a more efficient system

Methods: This was a prospective study over a period of 10 months [from 10^th January 2017 to 9^th November 2017] involving 64 babies. At a time, 2 babies were put on infusion pump continuous enteral feeding & 2 on conventional gravity bolus feeding, with a 15-day follow up. Parameters under study were – rate of weight gain, days to regain birth weight, days to switch over to regular spoon /paladai / jhinook-bati feeding, regurgitation, residual milk, abdominal distension, numbers and time durations of staff engaged in feeding of neonates. Babies were divided into 3 categories based on their weight at admission: 1). 900gm to 999gm-[12 babies] 2). 1000gm to 1249gm- [32 babies] 3). 1250 gm to 1500gm – [20 babies] Results: Babies on infusion pump continuous feeding gained weight faster and more in all three weight categories. Babies on continuous feeds by infusion pump started gaining weight sooner, on average 6 days post-admission as compared to 7 days post-admission when on bolus feeds. Birth weight re-attainment with infusion pump feeding was likewise sooner at 14.2 days compared to 15.8 days with bolus feeding. The number of episodes of regurgitation of feeds averaged 10 over the 15-day follow-up with infusion pump continuous feeding group, as compared to average 18 episodes with bolus enteral feeding. Gastric residual volume was very less [3.66 incidence] in infusion pump continuous enteral feeding compared to bolus enteral feeding [11 incidence]. Abdominal distension – infusion pump-4.33 against 7.67 in bolus enteral feed. In infusion pump continuous feed staff time is only 18 minutes for one baby compared to 120 minutes for one baby in bolus feed.Conclusions

1. Less incidence of regurgitation in continuous infusion pump feeding compared to gravity enteral feeding
2. Tolerates feed better (less residual volume, abdominal distention).
3. Weight gain better in 900gm to 999gm & 1000gm to 1499 gm
4. Engagement of staff significantly (6.7 times) less and cost-saving too!
5. Switchover to katori spoon later /comparable compared to gravity enteral feeding
6. More machine involvement
7. Accidental tube disconnection [rare]