Iranian Journal of Neonatology

Iranian Journal of Neonatology

Comparison of Behavior-based and Volume-based Feeding Methods on Blood Glucose Levels and Weight Gain in Premature Infants

Document Type : Original Article

Authors
Farzaneh Palizaban 1
Fahime Abolghasemi 2
Arya Behzadi 3
Pooya Poormehr 3
Elahe Rastkar 1
1 Clinical Research Development Center, Mahdiyeh Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Neonatology Department, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
10.22038/ijn.2026.82173.2582
Abstract
Background: This study was designed to compare blood glucose levels and weight gain in premature infants fed using cue-based feeding versus traditional volume-based feeding. Cue-based feeding relies on infants' behavioral cues, but concerns about hypoglycemia and the infant's inability to wake for feeding present challenges to its implementation.
Methods: This was a single-blind, randomized controlled clinical trial (IRCT: IRCT20240919063098N1) of 122 preterm infants allocated 1:1 to cue-based or volume-based feeding; caregivers could not be blinded, while assessors remained blinded. The primary outcome was weight trajectory (Day 1–3, Week 1, discharge). Secondary outcomes included preprandial glucose levels, caregiver-initiated wake-ups, feeding adverse events, length of stay, and postmenstrual age at discharge. Analysis was by intention-to-treat using mixed-effects models adjusted for admission weight and baseline feeding method.
Results: All 122 infants were analyzed. Cue-based feeding increased early weight gain: Day 1 +248 g (95% CI 120–376; P = 0.009), Day 2 +240 g (95% CI 96–384; P = 0.015); later differences were not significant. Glucose remained >60 mg/dL with no between-group effects or episodes of hypoglycemia. Wake-ups were significantly higher in the cue-based group (IRR 2.05, 95% CI 1.65–2.55; P < 0.001). Adverse events were infrequent and similar between groups. Length of stay did not differ significantly between groups (12 vs. 13 days, P = 0.217); postmenstrual age at discharge was comparable.
Conclusion: Cue-based feeding was associated with greater weight gain in the initial two days without compromising blood glucose levels. Further multicenter studies with larger sample sizes are recommended to validate these findings.
Keywords
Enteral nutrition
Hypoglycemia
Neonatal Intensive Care Units (NICUs)
Oral feeding
Weight gain
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Iranian Journal of Neonatology
Volume 17, Issue 3
Summer 2026
Pages 37-45