Enteral feeding induces diet-dependent mucosal dysfunction, bacterial proliferation, and necrotizing enterocolitis in preterm pigs on parenteral nutrition

2008 ◽  
Vol 295 (5) ◽  
pp. G1092-G1103 ◽  
Author(s):  
Charlotte R. Bjornvad ◽  
Thomas Thymann ◽  
Nicolaas E. Deutz ◽  
Douglas G. Burrin ◽  
Søren K. Jensen ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Necrotizing Enterocolitis ◽  
Enteral Feeding ◽  
Formula Feeding ◽  
Preterm Neonates ◽  
Bacterial Proliferation ◽  
Gut Dysfunction ◽  
Plasma Arginine ◽  
Mucosal Mass ◽  
Gut Maturation

Preterm neonates have an immature gut and metabolism and may benefit from total parenteral nutrition (TPN) before enteral food is introduced. Conversely, delayed enteral feeding may inhibit gut maturation and sensitize to necrotizing enterocolitis (NEC). Intestinal mass and NEC lesions were first recorded in preterm pigs fed enterally (porcine colostrum, bovine colostrum, or formula for 20–40 h), with or without a preceding 2- to 3-day TPN period ( n = 435). Mucosal mass increased during TPN and further after enteral feeding to reach an intestinal mass similar to that in enterally fed pigs without TPN (+60–80% relative to birth). NEC developed only after enteral feeding but more often after a preceding TPN period for both sow's colostrum (26 vs. 5%) and formula (62 vs. 39%, both P < 0.001, n = 43–170). Further studies in 3-day-old TPN pigs fed enterally showed that formula feeding decreased villus height and nutrient digestive capacity and increased luminal lactic acid and NEC lesions, compared with colostrum (bovine or porcine, P < 0.05). Mucosal microbial diversity increased with enteral feeding, and Clostridium perfringens density was related to NEC severity. Formula feeding decreased plasma arginine, citrulline, ornithine, and tissue antioxidants, whereas tissue nitric oxide synthetase and gut permeability increased, relative to colostrum (all P < 0.05). In conclusion, enteral feeding is associated with gut dysfunction, microbial imbalance, and NEC in preterm pigs, especially in pigs fed formula after TPN. Conversely, colostrum milk diets improve gut maturation and NEC resistance in preterm pigs subjected to a few days of TPN after birth.

scholarly journals Enteral feeding strategy for newborns with necrotizing enterocolitis

2020 ◽  
Vol 18 (4) ◽  
pp. 17-28
Author(s):  
A.I. Aminova ◽  
◽  
P.A. Bobkova ◽  
E.I. Belova ◽  
N.V. Zaytseva ◽  
...  
Keyword(s):  
Risk Factors ◽  
Parenteral Nutrition ◽  
Necrotizing Enterocolitis ◽  
Enteral Feeding ◽  
Gestational Age ◽  
Reproductive Technologies ◽  
Formula Feeding ◽  
Study Objective ◽  
Maternal Risk ◽  
Group I

Study objective. To optimize the recommendations on the strategy of enteral feeding for newborn babies with necrotizing enterocolitis (NEC). Patients and methods. A single-centre, observational, prospective, analytical, cohort study of 186 infants aged from 2 days to 2 months (96 boys, 90 girls) with the verified diagnosis of NEC of varied severity, who were treated at the neonatal pathology department of Moscow G.N.Speransky Children’s City Clinical Hospital No 9 in 2016-2018. The patients were divided into 2 groups, depending on disease staging according to the Walsh and Kliegman classification: group I – 124 (66.7%) newborns with mild NEC (stage 1A, B and 2A) and group II – 62 (33.3%) patients with a severe course (stages 2B and 3A, B). Results. As has been found, maternal risk factors for the development of severe forms of NEC in newborns are: maternal age over 40 years (OR = 1.40, 95% CI 0.83–2.17), assisted reproductive technologies (OR = 2.62, 95% CI 1.79–3.66), bad obstetrical-gynaecological history (OR = 1.80, 95% CI 1.03–2.97), infectious diseases during pregnancy (OR = 1.37, 95% CI 0.69–1.90). The ranking of the risk factors present in babies themselves permitted to find a causative relation with such factors as bacteriological contamination of biological media (OR = 2.80, 95% CI 1.3–4.0), bacteremia, viremia (OR = 5.80, 95% CI 2.99–7.13), gestational age 30–32 wks (OR = 2.35, 95% CI 1.01–3.94), which were significant only for mild forms of NEC. A minimal number of severe cases was diagnosed for a combination of breastfeeding and parenteral nutrition (16.7%), development of severe NEC was more often noted when feeding was started within 5 days: breastfeeding (26.3%), formula feeding (33.3 %), mixed breast and formula feeding (5%), or in infants who did not receive feeding due to their severe condition after birth (33%) (р < 0.05). The minimal number of severe NEC cases was found among babies who remained on breast (11.1%) and mixed (11.1%) feeding after the 5th day (р < 0.05), the maximal number – in infants who started from enteral feeding and were transferred to formula feeding (50%). Prolonged enteral feeding was three times more often associated with a severe course of NEC (р < 0.001). Conclusion. As has been found, the frequency of developing severe NEC depends on the character of the first feed after birth. A risk of developing severe forms of NEC decreases in newborns on breast- or mixed feeding, in combination of breast feeding and parenteral nutrition, short courses of enteral pauses, alternation of enteral feeding and enteral pauses. The results might be used in the clinical practice of neonatologists and paediatricians for prevention and management of NEC and its possible complications in newborn infants. Key words: necrotising enterocolitis, enteral pause, enteral nutrition, neonatology, birth weight, gestational age, premature infants

scholarly journals Relationship between arginine intake in parenteral nutrition and preterm neonatal population plasma arginine concentrations: a systematic review

2019 ◽  
Vol 77 (12) ◽  
pp. 878-889
Author(s):  
Chandini M Premakumar ◽  
Mark A Turner ◽  
Colin Morgan
Keyword(s):  
Systematic Review ◽  
Parenteral Nutrition ◽  
Study Design ◽  
Data Extraction ◽  
Research Question ◽  
Preterm Neonates ◽  
Very Preterm ◽  
Dose Concentration ◽  
Plasma Arginine ◽  
Relationship Of

AbstractContextVery preterm neonates (VPNs) are unable to digest breast milk and therefore rely on parenteral nutrition (PN) formulations. This systematic review was prepared following PRISMA-P 2015 guidelines. For the purpose of this review, desirable mean plasma arginine concentration is defined as ≥80 micromoles/L.ObjectiveThe review was performed to answer the following research question: “In VPNs, are high amounts of arginine in PN, compared with low amounts of arginine, associated with appropriate circulating concentrations of arginine?” Therefore, the aims were to 1) quantify the relationship between parenteral arginine intakes and plasma arginine concentrations in PN-dependent VPNs; 2) identify any features of study design that affect this relationship; and 3) estimate the target parenteral arginine dose to achieve desirable preterm plasma arginine concentrations.Data SourcesThe PubMed, Scopus, Web of Science, and Cochrane databases were searched regardless of study design; review articles were not included.Data ExtractionOnly articles that discussed amino acid (AA) intake and measured plasma AA profile post PN in VPNs were included. Data were obtained using a data extraction checklist that was devised for the purpose of this review.Data AnalysisTwelve articles met the inclusion criteria. The dose–concentration relationship of arginine content (%) and absolute arginine intake (mg/(kg × d)) with plasma arginine concentrations showed a significant positive correlation (P < 0.001).ConclusionFuture studies using AA solutions with arginine content of 17%–20% and protein intakes of 3.5–4.0 g/kg per day may be needed to achieve higher plasma arginine concentrations.

Postnatal amniotic fluid intake reduces gut inflammatory responses and necrotizing enterocolitis in preterm neonates

2013 ◽  
Vol 304 (10) ◽  
pp. G864-G875 ◽  
Author(s):  
Jayda Siggers ◽  
Mette V. Østergaard ◽  
Richard H. Siggers ◽  
Kerstin Skovgaard ◽  
Lars Mølbak ◽  
...  
Keyword(s):  
Amniotic Fluid ◽  
Necrotizing Enterocolitis ◽  
Enteral Feeding ◽  
Intestinal Inflammation ◽  
Inflammatory Responses ◽  
Preterm Neonates ◽  
Gut Colonization ◽  
Tnf Α ◽  
Before And After ◽  
And Migration

Preterm neonates are susceptible to gastrointestinal disorders such as necrotizing enterocolitis (NEC). Maternal milk and colostrum protects against NEC via growth promoting, immunomodulatory, and antimicrobial factors. The fetal enteral diet amniotic fluid (AF), contains similar components, and we hypothesized that postnatal AF administration reduces inflammatory responses and NEC in preterm neonates. Preterm pigs (92% gestation) were delivered by caesarean section and fed parental nutrition (2 days) followed by enteral (2 days) porcine colostrum (COLOS, n = 7), infant formula (FORM, n = 13), or AF supplied before and after introduction of formula (AF, n = 10) in experiment 1, and supplied only during the enteral feeding period in experiment 2 (FORM, n = 16; AF, n = 14). The NEC score was reduced in both AF and COLOS pigs, relative to FORM, when AF was provided prior to full enteral feeding (9.9 and 7.7 compared with 17.3, P < 0.05). There was no effect of AF when provided only during enteral feeding. AF pigs showed decreased bacterial abundance in colon and intestinal inflammation-related genes (e.g., TNF-α, IL-1α, IL-6, NOS) were downregulated, relative to FORM pigs with NEC. Anti-inflammatory properties of AF were supported by delayed maturation and decreased TNF-α production in murine dendritic cells, as well as increased proliferation and migration, and downregulation of IL-6 expression in intestinal cells (IEC-6, IPEC-J2). Like colostrum, AF may reduce NEC development in preterm neonates by suppressing the proinflammatory responses to enteral formula feeding and gut colonization when provided before the onset of NEC.

To Determine the Frequency of Necrotizing Enterocolitis in Preterm Infants

2021 ◽  
Vol 15 (12) ◽  
pp. 3200-3201
Author(s):  
Nusrat Hussain ◽  
Suleman . ◽  
Amna Wajdan ◽  
Rabia Bashir ◽  
Rabia Saleem ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
High Frequency ◽  
Cross Sectional Study ◽  
Formula Feeding ◽  
Preterm Neonates ◽  
Sectional Study ◽  
Cross Sectional ◽  
Medicine Department

Aim: To determine the frequency of necrotizing enterocolitis in preterm infants Place and duration of study: It is a descriptive cross-sectional study in Pediatric Medicine Department, Nishtar Hospital Multan from March, 2021 to August, 2021 Methodology: The preterm neonates were called for follow up every week for 4 weeks to diagnose Necrotizing enterocolitis. Results; Out of 174 cases, 101 (58%) were males while 73 (42%) were females. Necrotizing enterocolitis (NEC) was noted in 61 (35.1%) while NEC in breastfeeding infants was 14/74 (18.9%) and in formula feeding infants NEC was 47/100 (47%). Conclusion; High frequency of necrotizing enterocolitis was observed in this study among formula fed preterm infants as compared to breastfed preterm infants. Keywords; Breastfeeding, formula feeding, Necrotizing enterocolitis

scholarly journals The effect of early versus late lipid infusion in parenteral nutrition on the biochemical and cortical auditory evoked potential parameters in preterm neonates

2019 ◽  
Vol 67 (1) ◽  
Author(s):  
Rania Mohamed Abdou ◽  
Hoda Mahmoud Ibrahim Weheiba
Keyword(s):  
Weight Gain ◽  
Parenteral Nutrition ◽  
Biochemical Parameters ◽  
Evoked Potential ◽  
Demographic Data ◽  
Auditory Evoked Potential ◽  
Preterm Neonates ◽  
Lipid Infusion ◽  
Significant Difference ◽  
Cortical Auditory Evoked Potential

Abstract Background As brain activity depends greatly on the functions provided by lipid membranes, dietary fat in early life can affect the developing nervous system. Despite the adoption of an early more aggressive parenteral nutrition approach with amino acid infusions still reluctance to the early use of intravenous lipids in neonates. Aim To compare the effect of delayed versus early introduction of intravenous lipid in preterm on the biochemical parameters and on brain development by the cortical auditory evoked potential (CAEP) latency and amplitude. Methods This is a comparative study included 49 neonates admitted at the ain shams university NICUs. Participants were divided into two groups: 26 in group of early lipid infusion and 23 in late lipid infusion, Demographic data, and biochemical parameters were documented during the 1st 2 weeks of life. The CAEP was performed at age of 6 months. The latency and amplitude of P1 were recorded and compared between both groups. Results In the present work we found that group of early lipid infusion had reach their full oral intake earlier with shorter duration of parenteral nutrition and length of stay. They had better weight gain and significantly better glucose level control than group of late lipid infusion. There was no significant difference in the other chemical parameters between both groups expect for the higher incidence of cholestasis in the group of late lipid infusion. At 6 months of age, the group of early lipid infusion had significantly shorter latency and amplitude of P1 than the group of late lipid infusion. Conclusion Early effective nutrition positively affect feeding tolerance and weight gain and maturation of higher brain centers brain.

scholarly journals Enteral Feeding Strategies in Preterm Neonates ≤32 weeks Gestational Age: A Systematic Review and Network Meta-Analysis

2021 ◽  
pp. 1-17
Author(s):  
Viraraghavan Vadakkencherry Ramaswamy ◽  
Tapas Bandyopadhyay ◽  
Javed Ahmed ◽  
Prathik Bandiya ◽  
Sanja Zivanovic ◽  
...  
Keyword(s):  
Enteral Feeding ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Credible Interval ◽  
Stage Ii ◽  
Preterm Neonates ◽  
Feeding Strategies ◽  
Moderate Volume ◽  
Full Enteral Feeding ◽  
Critical Aspects

<b><i>Introduction:</i></b> Critical aspects of time of feed initiation, advancement, and volume of feed increment in preterm neonates remain largely unanswered. <b><i>Methods:</i></b> Medline , Embase, CENTRAL and CINAHL were searched from inception until 25th September 2020. Network meta-analysis with the Bayesian approach was used. Randomized controlled trials (RCTs) evaluating preterm neonates ≤32 weeks were included. Feeding regimens were divided based on the following categories: initiation day: early (&#x3c;72 h), moderately early (72 h–7 days), and late (&#x3e;7 days); advancement day: early (&#x3c;72 h), moderately early (72 h–7 days), and late (&#x3e;7 days); increment volume: small volume (SV) (&#x3c;20 mL/kg/day), moderate volume (MoV) (20–&#x3c; 30 mL/kg/day), and large volume (≥30 mL/kg/day); and full enteral feeding from the first day. Sixteen regimens were evaluated. Combined outcome of necrotizing enterocolitis (NEC) stage ≥ II or mortality before discharge was the primary outcome. <b><i>Results:</i></b> A total of 39 studies enrolled around 6,982 neonates. Early initiation (EI) with moderately early or late advancement using MoV increment enteral feeding regimens appeared to be most efficacious in decreasing the risk of NEC or mortality when compared to EI and early advancement with SV increment (risk ratio [95% credible interval]: 0.39 [0.12, 0.95]; 0.34 [0.10, 0.86]) (GRADE–very low). <b><i>Conclusions:</i></b> Early initiated, moderately early, or late advanced with MoV increment feeding regimens might be most appropriate in decreasing the risk of NEC stage ≥II or mortality. In view of the certainty of evidence being very low, adequately powered RCTs evaluating these 2 strategies are warranted.

Placental Transfusion, Timing of Plastic Wrap or Bag Placement, and Preterm Neonates

2021 ◽  
Author(s):  
William Engle ◽  
Izlin Lien ◽  
Brian Benneyworth ◽  
Jennifer Stanton Tully ◽  
Alana Barbato ◽  
...  
Keyword(s):  
Necrotizing Enterocolitis ◽  
Outcome Data ◽  
Delivery Room ◽  
Respiratory Support ◽  
Preterm Neonates ◽  
Quality Improvement Initiative ◽  
Delayed Cord Clamping ◽  
Cord Clamping ◽  
Simultaneous Group ◽  
Sequential Group

Objective Compare delivery room practices and outcomes of infants born at less than 32 weeks' gestation or less than 1,500 g who have plastic wrap/bag placement simultaneously during placental transfusion to those receiving plastic wrap/bag placement sequentially following placental transfusion. Study Design Retrospective analysis of data from a multisite quality improvement initiative to refine stabilization procedures pertaining to placental transfusion and thermoregulation using a plastic wrap/bag. Delivery room practices and outcome data in 590 total cases receiving placental transfusion were controlled for propensity score matching and hospital of birth. Results The simultaneous and sequential groups were similar in demographic and most outcome metrics. The simultaneous group had longer duration of delayed cord clamping compared with the sequential group (42.3 ± 14.8 vs. 34.1 ± 10.3 seconds, p < 0.001), and fewer number of times cord milking was performed (0.41 ± 1.26 vs. 0.86 ± 1.92 seconds, p < 0.001). The time to initiate respiratory support was also significantly shorter in the simultaneous group (97.2 ± 100.6 vs. 125.2 ± 177.6 seconds, p = 0.02). The combined outcome of death or necrotizing enterocolitis in the simultaneous group was more frequent than in the sequential group (15.3 vs. 9.3%, p = 0.038); all other outcomes measured were similar. Conclusion Timing of plastic wrap/bag placement during placental transfusion did affect duration of delayed cord clamping, number of times cord milking was performed, and time to initiate respiratory support in the delivery room but did not alter birth hospital outcomes or respiratory care practices other than the combined outcome of death or necrotizing enterocolitis. Key Points

Questions About Early Enteral Feeding Study

PEDIATRICS ◽  
1987 ◽  
Vol 79 (1) ◽  
pp. 168-168
Author(s):  
LAWRENCE GRYLACK
Keyword(s):  
High Risk ◽  
Adenosine Triphosphate ◽  
Necrotizing Enterocolitis ◽  
Enteral Feeding ◽  
Animal Studies ◽  
Bowel Ischemia ◽  
Feeding Study ◽  
Early Enteral Feeding ◽  
Mucosal Cells

To the Editor.— I would like to comment on the article by Ostertag et al, "Early Enteral Feeding Does Not Affect the Incidence of Necrotizing Enterocolitis" (Pediatrics 1986;77:275-280). Support for the concept of early gastrointestinal nutrition in the high-risk newborn comes from animal studies that showed that dogs with bowel ischemia that were given intraluminal substrate (10% glucose) had higher levels of adenosine triphosphate in mucosal cells and less morphologic damage than animals without that infusion.1

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