Granulocyte Colony-Stimulating Factor (G-CSF): Is It Effective for Feeding Tolerance in Very Low Birth Weight Infants?

Background: Feeding intolerance is one of the most common problems in very low birth weight infants. Granulocyte colony-stimulating factor (G-CSF), one of the cytokines in amniotic fluid and human milk, plays an important role in gut maturation. Objectives: The aim of this study was to evaluate the effect of oral administration of G-CSF on feeding tolerance in preterm infants weighing ≤ 1200 g. Methods: This randomized, single-blind, placebo-controlled clinical study was conducted between September 2018 and June 2019 on preterm infants (≤ 32 weeks) weighing ≤ 1200 g and matched in terms of gestational age, birth weight, and umbilical cord pH. The intervention group received G-CSF by gavage simultaneously with the start of enteral feeding stopped after 10 days. The primary outcome was the duration of infant milk that reached 50, 75, and 100 mL/kg/day, and the secondary outcomes were the onset of weight gain and the length of hospital stay. Results: Out of 68 eligible infants, 31 infants in each group completed the study. There was no significant difference between the two groups in terms of the length of hospital stay and the duration of reaching a feeding volume of 50 and 75 mL/kg/day; nonetheless, the duration of reaching a feeding volume of 100 mL/kg/day and the time to start gaining weight in the case group were significantly shorter than those of the control group (P = 0.029 and P = 0.002, respectively). Conclusions: The oral administration of G-CSF in preterm infants ≤ 1200 g improves feeding tolerance and can further shorten the time to reach full enteral feeding.