Effect of oral colostrum application every 2 hours and 4 hours in order to achieve trophic feeding in preterm infants: A randomized controlled trial

Introduction: Enteral feeding in preterm neonates starts with trophic feeding, which is the practice of feeding minute volumes of enteral feeds (starting at 10-25mL/kg/day) through an orogastric tube. Colostrum has protective effects, such as anti-inflammatory, immunomodulatory, and antimicrobial effects. The oral colostrum application is a safe, effective and economical therapy. However, the most optimal frequency of the oral colostrum application is not yet conclusive. This study aims to evaluate the effects of applying colostrum orally every 4 and 2 hours in order to achieve trophic feeding in preterm infants. Materials and Methods: In this randomized controlled trial with an open-label design, very-low-birth-weight neonates admitted to RSUP Dr. Sardjito from March to August 2023 were allocated to receive oral colostrum applications either every two hours or every four hours. Subjects were randomized into study groups using a random block size of four through computer-generated in a 1:1 ratio. The primary outcome was the time to achieve trophic feeding. The extraneous variables were necrotizing enterocolitis, sepsis, hemodynamically significant Patent Ductus Arteriosus (hsPDA) and gender. Data analysis was conducted using SPSS. Results: A total of 40 neonates were analyzed for primary outcome. Of these, 20 neonates received oral colostrum applications every 2 hours, and the other 20 subjects were fed every 4 hours. Bivariate analysis showed that colostrum application given every 4 hours achieved the trophic feeding 0.47 day faster than the colostrum application every 2 hours. However, the difference between the two feeding methods was not statistically significant (p=0.703). Conclusion: There is no significant difference in achieving trophic feeding in preterm neonates (less than 34 weeks) whether the colostrum was given every 2 or 4 hours. © 2025, Malaysian Medical Association. All rights reserved.