Lysine kinetics in preterm infants: the importance of enteral feeding

Abstract Background The factors that determine the effect of enteral feeding on intestinal perfusion after preterm birth remain largely unknown. We aimed to determine the effect of enteral feeding on intestinal oxygen saturation (rintSO2) in preterm infants and evaluated whether this effect depended on postnatal age (PNA), postmenstrual age (PMA), and/or feeding volumes. We also evaluated whether changes in postprandial rintSO2 affected cerebral oxygen saturation (rcSO2). Methods In a longitudinal observational pilot study using near-infrared spectroscopy we measured rintSO2 and rcSO2 continuously for two hours on postnatal Days 2 to 5, 8, 15, 22, 29, and 36. We compared preprandial with postprandial values over time using multi-level analyses. To assess the effect of PNA, PMA, and feeding volumes, we performed Wilcoxon signed-rank tests or logistic regression analyses. To evaluate the effect on rcSO2, we also used logistic regression analyses. Results We included 29 infants: median (range) gestational age 28.1 weeks (25.1–30.7) and birth weight 1025 g (580–1495). On Day 5, rintSO2 values decreased postprandially: mean (SE) 44% (10) versus 35% (7), P = .01. On Day 29, rintSO2 values increased: 44% (11) versus 54% (7), P = .01. Infants with a PMA ≥ 32 weeks showed a rintSO2 increase after feeding (37% versus 51%, P = .04) whereas infants with a PMA < 32 weeks did not. Feeding volumes were associated with an increased postprandial rintSO2 (per 10 mL/kg: OR 1.63, 95% CI, 1.02–2.59). We did not find an effect on rcSO2 when rintSO2 increased postprandially. Conclusions Our study suggests that postprandial rintSO2 increases in preterm infants only from the fifth week after birth, particularly at PMA ≥ 32 weeks when greater volumes of enteral feeding are tolerated. We speculate that at young gestational and postmenstrual ages preterm infants are still unable to increase intestinal oxygen saturation after feeding, which might be essential to meet metabolic demands. Trial registration For this prospective longitudinal pilot study we derived patients from a larger observational cohort study: CALIFORNIA-Trial, Dutch Trial Registry NTR4153.

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Faster Gastric Emptying Is Unrelated to Feeding Success in Preterm Infants: Randomized Controlled Trial

Nutrients ◽

10.3390/nu11071670 ◽

2019 ◽

Vol 11 (7) ◽

pp. 1670 ◽

Cited By ~ 4

Author(s):

Maria Elisabetta Baldassarre ◽

Antonio Di Mauro ◽

Osvaldo Montagna ◽

Margherita Fanelli ◽

Manuela Capozza ◽

...

Keyword(s):

Gastric Emptying ◽

Preterm Infants ◽

Enteral Feeding ◽

Controlled Trial ◽

Pearson Correlation ◽

Intact Protein ◽

Feeding Success ◽

Hydrolyzed Protein ◽

To Receive ◽

Full Enteral Feeding

Objectives: To evaluate the relationship between gastric emptying (GE) time and days to achievement of full enteral feeding (≥140 mL/kg/day) in preterm infants randomly assigned to receive one of two marketed study formulas for the first 14 feeding days: intact protein premature formula (IPF) or extensively hydrolyzed protein (EHF) formula. Methods: In this triple-blind, controlled, prospective, clinical trial, we report GE time (time to half-emptying, t1/2) by real-time ultrasonography on Study Day 14, in preterm infants receiving IPF or EHF formula. The association between GE time and achievement of full enteral feeding was evaluated by Pearson correlation. Per-protocol populations for analysis included participants who (1) completed the study (overall) and (2) who received ≥ 75% study formula intake (mL/kg/day). Results: Median GE time at Day 14 was significantly faster for the EHF vs. IPF group overall and in participants who received ≥ 75% study formula intake (p ≤ 0.018). However, we demonstrated GE time had no correlation with the achievement of full enteral feeding (r = 0.08; p = 0.547). Conclusion: Feeding IP premature formula vs. EH formula was associated with shorter time to full enteral feeding. However, faster GE time did not predict feeding success and may not be a clinically relevant surrogate for assessing feeding tolerance.

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Does selective evaluation of gastric aspirates in preterm infants influence time to full enteral feeding?

Journal of Paediatrics and Child Health ◽

10.1111/jpc.14993 ◽

2020 ◽

Vol 56 (7) ◽

pp. 1150-1154

Author(s):

Lydia Kennedy ◽

Thomas Rogerson ◽

Amy Kate Keir

Keyword(s):

Preterm Infants ◽

Enteral Feeding ◽

Full Enteral Feeding

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Effect of Patent Ductus Arteriosus on Splanchnic Oxygenation at Enteral Feeding Introduction in Very Preterm Infants

Journal of Pediatric Gastroenterology and Nutrition ◽

10.1097/mpg.0000000000002420 ◽

2019 ◽

Vol 69 (4) ◽

pp. 493-497 ◽

Cited By ~ 1

Author(s):

Silvia Martini ◽

Luigi Corvaglia ◽

Arianna Aceti ◽

Francesca Vitali ◽

Giacomo Faldella ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Enteral Feeding ◽

Ductus Arteriosus ◽

Very Preterm Infants ◽

Very Preterm ◽

Splanchnic Oxygenation ◽

Patent Ductus

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Preterm Nutrition and Clinical Outcomes

Global Pediatric Health ◽

10.1177/2333794x20937851 ◽

2020 ◽

Vol 7 ◽

pp. 2333794X2093785

Author(s):

Netsanet Workneh Gidi ◽

Amha Mekasha ◽

Assaye K. Nigussie ◽

Robert L. Goldenberg ◽

Elizabeth M. McClure ◽

...

Keyword(s):

Clinical Outcomes ◽

Preterm Infants ◽

Enteral Feeding ◽

Low Income ◽

Neonatal Intensive Care ◽

Low Income Countries ◽

Preterm Neonates ◽

Risk Of Death ◽

Increased Risk ◽

Preterm Formula

Background. In low-income countries, preterm nutrition is often inadequately addressed. The aim of the study was to assess the patterns of feeding and associated clinical outcomes of preterm neonates admitted to neonatal intensive care units in Ethiopia. Method. This was a multicenter, prospective study. Infants’ clinical characteristics at birth, daily monitoring of feeding history, and weight measurements were collected. An outcome assessment was completed at 28 days. Result. For this analysis, 2560 infants (53% male) were eligible. The mean (SD) gestational age was 33.1 (2.2) weeks. During the hospital stay the proportion of infants on breast milk only, preterm formula, term formula, and mixed feeding was 58%, 27.4%, 1.6%, and 34.1%, respectively. Delay in enteral feeding was associated with increased risk of death (odds ratio [OR] = 1.92, 95% confidence interval [CI] = 1.33-2.78; P < .001) and (OR = 5.06, 95% CI = 3.23-7.87; P < .001) for 1 to 3 and 4 to 6 days of delay in enteral feeding, respectively, after adjusting for possible confounders. The length of delay in enteral feeding was associated with increased risk of hypoglycemia (OR = 1.2, 95% CI = 1.1-1.2; P = .005). The mortality rate was lower in hospitals providing preterm formula more often ( P = .04). Half of the infants continued losing weight at the time of discharge. Conclusion. Delayed enteral feeding significantly increases the risk of mortality before discharge and hypoglycemia in preterm infants in resource-limited settings. Ensuring adequate nutritional support of preterm infants is highly needed.

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