Umbilical artery catheters do not affect intestinal blood flow responses to minimal enteral feedings (original) (raw)
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Acta Paediatrica, 2004
Aims-To evaluate whether serial Doppler measurements of superior mesenteric artery (SMA) blood flow velocity after the first enteral feed could predict early tolerance to enteral feeding in preterm infants. Methods-When clinicians decided to start enteral feeds, Doppler ultrasound blood flow velocity in the SMA was determined before and after a test feed of 0.5 ml milk. The number of days taken for infants to tolerate full enteral feeding (150 ml/kg/ day) was recorded. Results-Fourteen infants (group 1) achieved full enteral feeding within seven days. Thirty infants (group 2) took 8-30 days. There was no diVerence in the preprandial time averaged mean velocity (TAMV) between the groups at a median age of 3 (2-30) days. In group 1, there was a significant increase in TAMV (p<0.01) above the preprandial level at 45 and 60 minutes, but this did not occur in group 2. An increase in TAMV by more than 17% at 60 minutes has a sensitivity of 100% and a specificity of 70% for the prediction of early tolerance to enteral feeds. Conclusions-There is a significant correlation between an increase in mean SMA blood flow velocity and early tolerance of enteral feeding. Doppler measurements of SMA blood flow velocity may be useful for deciding when to feed high risk preterm infants.
IOSR Journals , 2019
This study was done to compare early enteral feeding in preterm IUGR neonates with AREDF on Umbilical artery with preterm IUGR with normal umbilical artery Doppler for time required to attain full enteral feed and increased risk of feed intolerance (FI).METHODS: A Reterospective observational analytical study of preterm intrauterine growth restricted neonates of 28 to 34 weeks with birht weight of > 800 gms, who fed within 24 hour of admission in NICU enrolled from 1 st November 2017 to 31 October 2018 were included in analysis. Primary outcomes were Time (in days) required to attain full enteral feed volume and incidence of feed intolerance in neonates fed early. Clinical characteristics were compared between the groups of SGA infants with normal and AREDF. RESULTS: A total of 323 infants with GA<34 weeks and BW<10th percentile were admitted. Of these 102 infants were included in the study, 51 had AREDF and 51 had normal doppler flow in umbilical artery .Infants with AREDF were smaller (1119.9 g vs. 1222.8 g, p = 0.01) and less mature (31.38wks vs. 32.2wks, p = 0.02).Higher proportion of infants with AREDF have PIH in mother those with normal Doppler flow (55% vs. 28%, p = 0.005). In our study,the time required for full enteral feed 11.15 vs 10.40 (in days), p=.46 and incidence of feed intolerance (13% vs. 12%) ,p=.88 was more in AREDF group but it was statistically not significant .Incidence of NEC (8% vs 6%),p=.84 ,Time to regain birth weight and Length of hospital stay is more 20.53 vs 19.84, p=.57, and 42.77 vs 37.28, p=.95 respectively, in AREDF group but was statistically not significant CONCLUSION: No significant difference in incidence of feed intolerance and NEC, time reqired to attain full enteral feed was found between early feeding in preterm IUGR neonates with AREDF on antenatal UA Doppler compare with preterm neonates with normal UA Doppler.
International Journal of Advanced Research, 2019
Preterm very low birth infants are not fed early if there is shock or severe sepsis or respiratory distress. Traditionally if infants are sick enteral feedings are introduced slowly (at 4-5 days of age). Infants born with history of AREDF are given parenteral nutrition till enteral intake is adequate (7-10 days). We studied the effect of early MEN (at 24 hours of age) in VLBW (<32 weeks gestation) infants with AREDF (MEN group-n=12;controls-n=14). The results of this study reveals that the outcome of infants fed with early MEN is better with shorter length of stay, faster regaining of birth weight, shorter duration of parenteral nutrition and better tolerance of feedings. These data suggest that early MEN can be safely implemented in preterm VLBW infants with history of AREDF with no adverse outcomes.
SLJCH, 2023
Background: Necrotising enterocolitis (NEC) is the commonest and most serious gastrointestinal neonatal emergency. In preterm infants with evidence of abnormal Doppler flow velocities in the fetal umbilical artery, suboptimal intestinal perfusion is postulated to increase the risk of feed intolerance and NEC. Objectives: To compare the effect of slow versus rapid enteral feeding in preterm neonates with abnormal antenatal umbilical artery Doppler. Method: This is a randomised controlled trial; we randomised into a slow and a fast group; we randomised separately into subcategories based on the weight. Sample size was calculated as 82. Data analysis was done using SPSS version 23. For group comparisons of categorical data, Chi-squared test was used. If expected frequency in the contingency tables was <5 for more than 25% cells, Fisher's exact test was used. For non-parametric continuous data Mann-Whitney test was applied. Statistical significance was kept at p<0.05 and power at 80%. Results: In neonates with slow and rapid feeding with birth weight <1250g, percentage of 2b (30% and 26.7% respectively) was more compared to other stages, whereas in group with birth weight ≥1250g rapid feeding group Ia (14.3%) was more in slow feeding group and 1a and 2a equal in rapid feeding group with no statistical significance. The mean duration of stay hospital was less in rapid ________________________________________ 1
BMC Pediatrics, 2012
Background: IUGR infants are thought to have impaired gut function after birth, which may result in intestinal disturbances, ranging from temporary intolerance to the enteral feeding to full-blown NEC. In literature there is no consensus regarding the impact of enteral feeding on intestinal blood flow and hence regarding the best regimen and the best rate of delivering the enteral nutrition. Methods/design: This is a randomized, non-pharmacological, single-center, cross-over study including 20 VLBW infants. Inclusion criteria * Weight at birth ranging: 700-1501 grams * Gestational age up to 25 weeks and 6 days * Written informed consent from parents or guardians Exclusion criteria * Major congenital abnormality * Patients enrolled in other trials * Significant multi-organ failure prior to trial entry * Pre-existing cutaneous disease not allowing the placement of the NIRS' probe
Critical Care Medicine, 2009
Alterations in splanchnic blood flow cause gut ischemia and may predispose to gut-derived sepsis. Increases in superior mesenteric artery (SMA) blood flow occur follow the oral ingestion of food, but the effects of enteral nutrition (EN) on splanchnic perfusion are poorly defined and those of parenteral nutrition (PN) are unknown in humans. The aim of this study was to investigate changes in SMA flow in healthy controls and patients receiving adjuvant nutrition. Design: Qualitative before-after study. Setting: Intensive care and general wards at Scarborough Hospital, Scarborough, United Kingdom. Patients: Fourteen healthy volunteers and 20 consecutive hemodynamically stable patients receiving adjuvant nutrition. Interventions: Oral, EN, or PN after an overnight fast. Measurements and Main Results: Duplex ultrasonography was used to assess SMA flow after an overnight fast. Subjects were then rescanned 3 hrs later after commencement of the appropriate test feed so that postprandial flows could be determined. Of the 20 patients recruited, 10 were receiving EN (120 kcal) and 10 PN (175 kcal). Of the 14 volunteers, three received no feed before their second scan (controls), six received an oral meal (530 kcal), and five received EN (120 kcal). Changes in SMA flow within groups were assessed. The control (fasting) volunteers showed no change between the two scans (p ؍ 1.000). All subjects fed intraluminally demonstrated significant increases in postprandial SMA blood flow. Conversely, all patients fed parenterally showed decreased postprandial SMA flows with a median (interquartile range) fasting SMA flow of 14.5 (4.8-24.8) mL/sec, which decreased to 6.1 (2.4-9.2) mL/sec postprandially (p ؍ 0.013). Conclusions: Splanchnic flow is modulated by the route of feeding. The clinical significance of these findings requires further investigation as they may be important in the management of the critically ill patient, particularly in those with cardiovascular instability or any patient predisposed to gut ischemia.
Does patent ductus arteriosus affect feed tolerance in preterm neonates?
Archives of Disease in Childhood - Fetal and Neonatal Edition, 2007
Patent ductus arteriosus (PDA), especially PDA with sepsis, has been reported as a risk factor for feed intolerance in preterm neonates. In this study, the start to full feeds interval was found to be longest in preterm neonates ((28 weeks' gestation) with sepsis, followed by that in preterm neonates with sepsis and PDA, and in those with PDA alone.