Transpyloric feeding in small preterm infants.

Wolfsdorf, J., Makarawa, S., Fernandes, C., Fenner, A. (1975). Archives of Disease in Childhood, 50, 723. Transpyloric feeding in small preterm infants. In 20 preterm infants, birthweight ranging from 775 to 1540 g, transpyloric feeding was carried out using expressed human milk as the sole nutrient (study group). 10 further infants, birthweight range 910-1500 g, were also fed with human milk via nasogastric tube (control group). The group fed transpylorically had higher fluid intakes during the early days of life. Body weight loss after birth was similar in both groups, but subsequent weight gain was more rapid in the study group. Thus transpyloric feeding is considered to offer the following advantages in comparison with nasogastric feeding. (1) No danger of aspiration after vomiting. (2) More rapid weight gain.     

Transpyloric feeding in gastroesophageal-reflux-associated apnea in premature infants

OBJECTIVE: The aetiological role of gastroesophageal reflux in apnea of prematurity is controversial. We hypothesized that transpyloric feeds, which decreases reflux and aspiration, will not be associated with decrease in reflux-related apnea. STUDY DESIGN: The shows retrospective chart review of 41 premature babies on transpyloric feeds. Fifteen infants meeting the inclusion criteria of apnea of prematurity and clinical evidence of gastroesophageal reflux were included. Primary data points were number of apneas before and after transpyloric feeds. t-statistics was used for analysis. RESULTS: Twelve of the 15 babies showed significant improvement on transpyloric feeds (p <. 005). The nonresponders were identified within 48 h. After discontinuation of transpyloric feeds, 2 responders underwent antireflux surgery and 9 were discharged without further intervention. No transpyloric-tube-related complication was documented. CONCLUSION: Transpyloric feeds may be useful for diagnosis and management of suspected gastroesophageal-reflux-associated apnea in a selected group of infants.     

早产儿及小于胎龄儿喂养困难研究进展

早产儿及小于胎龄儿喂养困难是普遍存在的问题,发病率高。影响早产儿及小于胎龄儿喂养困难的因素有很多,包括窒息、原发疾病、胎龄、开奶时间、孕期因素、环境因素、激素水平等,该文就早产儿及小于胎龄儿喂养困难病因、治疗进行综述,旨在为早产儿及小于胎龄儿喂养困难的防治及进一步研究提供基础。     

Methods of enteral feeding in preterm infants

Whenever possible, oral feeding is the preferred method in neonatal feeding. However, many premature infants are unable to suck and swallow effectively; in these cases alternative methods of nutrient delivery must be used. We briefly review the different feeding methods used in neonatal units, with particular attention to their theoretical advantages, disadvantages and to the current best evidence available.     

Ghrelin and feeding behaviour in preterm infants

The importance of early life events in the development of metabolic diseases is well recognized. Early postnatal environment, including nutrition, is key to future health, and this is particularly true for preterm infants. It is important that these infants receive sufficient nutrients to prevent growth restriction and promote neurodevelopment, while minimizing predisposition to metabolic diseases later in life. Feeding habits are the fundamental elements of nutrition and are influenced by many factors, including personal and familial habits, socioeconomic status, and cultural environment. In the last decades, there has been an important scientific interest toward the comprehension of the molecular and neural mechanisms regulating appetite. In these networks, act many peptide hormones produced in brain or gut, among which ghrelin is important because of its action in the short-term regulation of food intake and the long-term regulation of body weight. Ghrelin stimulates appetite and plays a role in regulating feeding behaviour. Ghrelin levels vary from fetal life through to early adulthood, with the highest levels observed in the very early years. Cord ghrelin levels have been evaluated in term and preterm newborns and high ghrelin levels have been observed in small-for-gestational age newborns and in newborns with intrauterine growth restriction. Moreover, ghrelin has been detected in term and preterm human breast milk, suggesting that it may play a role in the development of neuroendocrine pathways regulating appetite and energy homeostasis in early life. However, more research is required to better define ghrelin's role in breast milk and on feeding behaviour.     

Mechanisms of feeding efficiency in preterm infants

Nutritive sucking was studied in 18 preterm infants. Differences in feeding efficiency could not be explained by differences in sucking rate. Quick efficient drinking, however, was characterized by long sucking bursts and by a large amount of milk intake during each sucking movement. Slow inefficient drinking was characterized by short sucking bursts and by a small amount of milk intake during each sucking movement.     

Neonatal small intestinal motility: motor responses to feeding in term and preterm infants

To explore the possibility that the intestinal motor response to feeding is intact even in infants with immature fasting patterns, we performed low-compliance, continuous-infusion manometry in 13 term and 23 preterm infants during the first postnatal week. Babies were fed a standard formula intraduodenally at 4 ml/kg/2 hr by infusion pump. Small bowel motility responded to feeding; fasting patterns were replaced with long periods of persistent activity. During the infusion of formula, there was no significant difference in motor activity between preterm and term infants. Four characteristics of motor activity changed with feeding: motility index, the number of pressure peaks per 30-minute period, mean amplitude of pressure peaks, and duration of periods of quiescence. The number of pressure peaks per 30-minute period was the most sensitive index of the motor response to feeding, and it was used to characterize the fed pattern response. The start and duration of the fed response were similar in both groups of infants. Thus, despite the presence of immaturity in fasting patterns, the intestine of the preterm infant responds appropriately to feeding. These data help explain why preterm infants usually tolerate antral feedings, and support their use.     

早产儿胃肠喂养不耐受的新疗法

目的研究生大黄粉对早产儿喂养不耐受的冶疗作用。方法将73例诊断为早产儿喂养不耐受患儿随机分为2组,均采用鼻(口)饲胃管喂养,治疗组在常规治疗基础上加用中药生大黄粉100 mg/(kg.次),每天2~3次,于喂奶前30 min喂入。结果应用生大黄粉干预治疗后,每天奶量增加,胃潴留量减少,体重增加,与对照组比较,差异有显著性(P<0.01)。结论应用生大黄粉治疗早产儿喂养不耐受疗效好,价格便宜,值得推广。     

Decreased ventilation in preterm infants during oral feeding

As respiratory difficulty may accompany nipple feeding in preterm neonates, we studied the effect of oral feeding on ventilation in 23 preterm infants. The infants composed two groups based on their postconceptional age at the time of study: Group A comprised 12 infants 34 to 35.9 weeks of age, and group B, 11 infants 36 to 38 weeks. Ventilation was measured via a nasal mask pneumotachometer, and sucking pressure via a nipple that also permitted milk delivery; transcutaneous PO2 and PCO2 were continuously monitored. The feeding pattern comprised an initial period of continuous sucking of at least 30 seconds, followed by intermittent sucking bursts for the remainder of the feed. When compared with an initial semi-upright control period, minute ventilation (V1) during continuous sucking fell by 52 +/- 6% (P less than 0.001) and 40 +/- 2% (P less than 0.001) in groups A and B, respectively. This was the result of a decrease in respiratory frequency and tidal volume and was associated with a fall in TcPO2 of 13 +/- 4 mm Hg (P less than 0.01) in group A and 10 +/- 2 mm Hg (P less than 0.01) in group B. During intermittent sucking, V1 and TcPO2 recovered partially only in the more mature infants (group B). At the end of the feed, TcPCO2 have risen by 3 +/- 1 mm Hg (P less than 0.001) in group A and by 2 +/- 2 mm Hg (P less than 0.05) in group B. Thus oral feeding results in an impairment of ventilation during continuous sucking and the subsequent recovery during intermittent sucking is dependent on postconceptional age.     

Maturation of oral feeding skills in preterm infants

AIM: Safe and successful oral feeding requires proper maturation of sucking, swallowing and respiration. We hypothesized that oral feeding difficulties result from different temporal development of the musculatures implicated in these functions. METHODS: Sixteen medically stable preterm infants (26 to 29 weeks gestation, GA) were recruited. Specific feeding skills were monitored as indirect markers for the maturational process of oral feeding musculatures: rate of milk intake (mL/min); percent milk leakage (lip seal); sucking stage, rate (#/s) and suction/expression ratio; suction amplitude (mmHg), rate and slope (mmHg/s); sucking/swallowing ratio; percent occurrence of swallows at specific phases of respiration. Coefficients of variation (COV) were used as indices of functional stability. Infants, born at 26/27- and 28/29-week GA, were at similar postmenstrual ages (PMA) when taking 1-2 and 6-8 oral feedings per day. RESULTS: Over time, feeding efficiency and several skills improved, some decreased and others remained unchanged. Differences in COVs between the two GA groups demonstrated that, despite similar oral feeding outcomes, maturation levels of certain skills differed. CONCLUSIONS: Components of sucking, swallowing, respiration and their coordinated activity matured at different times and rates. Differences in functional stability of particular outcomes confirm that maturation levels depend on infants' gestational rather than PMA.     

早产儿喂养不耐受临床特征分析

目的：探讨早产儿喂养不耐受的临床特征,为早产儿喂养不耐受的防治提供临床依据。方法：2007年1月至2009年12月入住新疆医科大学第一附属医院的早产儿716例为研究对象,对其临床特征进行回顾性分析。结果：①716例早产儿中197例(27.5%)发生喂养不耐受,其中极低出生体重儿喂养不耐受发生比率高达77.6%。临床表现中以单纯胃潴留所占比例最高(47.2%)。②喂养不耐受出现时间集中在开始喂养后3 d内。③喂养不耐受组早产儿胎龄和出生体重低于耐受组、开奶时间晚于耐受组、早产儿合并窒息及呼吸性疾病比例高于耐受组（P＜0.05）;而民族、性别、孕母年龄、分娩方式、有无宫内窘迫两组差别无统计学意义（P＞0.05）。随着胎龄增大、出生体重增加、尽早开始喂养,早产儿喂养不耐受发生风险降低。结论：早产儿喂养不耐受的发生与患儿胎龄、出生体重、开奶时间及合并症有关。     

Eczema and early solid feeding in preterm infants

Aims: To establish whether development of eczema is influenced by feeding practices in preterm infants, while taking account of confounding factors. Methods: Data were assembled from 257 infants born prematurely and studied to 12 months post-term. Logistic regression analysis was performed to establish the association between feeding practices and eczema, allowing for potential confounding factors including the infants'' gender, parental atopic status, social background, and parental smoking habits. Results: For the development of eczema (with or without other symptoms) by 12 months post-term, the introduction of four or more solid foods by or before 17 weeks post-term was a significant risk (odds ratio 3.49). Male infants were at significantly higher risk (odds ratio 1.84). In addition, having non-atopic parents who introduced solid foods before 10 weeks post-term or having at least one atopic parent represented a significant risk scenario (odds ratio 2.94). Conclusions: Early introduction of a diverse range of solid foods may predispose the preterm infant to eczema development by 12 months post-term. Furthermore, non-atopic parents who practice early as opposed to late introduction of solid foods may be exposing preterm infants to a greater risk of eczema by 12 months post-term.     

Early feeding after necrotizing enterocolitis in preterm infants

OBJECTIVE: To report our experience with an early initiation of enteral feedings after necrotizing enterocolitis (NEC). STUDY DESIGN: Over a 4-year period, all inborn infants with NEC Bell stage II or greater received enteral feedings, increased by 20 mL/kg/d, once no portal vein gas had been detected on ultrasound for 3 consecutive days (group 1). Infants were compared with a historic comparison group (group 2). RESULTS: Necrotizing enterocolitis rates were 5% (26/523) in the early feeding group and 4% (18/436) in the comparison group. One early feeding infant and two comparison group infants died of NEC, whereas two and one, respectively, had recurrent NEC. Enteral feedings were restarted at a median of 4 days (range, 3-14) versus 10 days (range, 8-22) after onset of NEC. Early feeding was associated with shorter time to reach full enteral feedings (10 days [range, 7-31] vs 19 days [range, 9-76], P<.001), a reduced duration of central venous access (13.5 days [range, 8-24] vs 26.0 days [range, 8-39], P<.01), less catheter-related septicemia (18% vs 29%, P<.01), and a shorter duration of hospital stay (63 days [range, 28-133] vs 69 days [range, 36-150], P<.05). CONCLUSION: Early enteral feeding after NEC was associated with significant benefits and no apparent adverse effects. This study was underpowered, however, to exclude a higher NEC recurrence risk potentially associated with this change in practice.     

早产儿喂养的新理念

随着早产儿尤其极低出生体重儿存活率的逐年升高,人们越来越关注早期营养对早产儿生长、疾病转归和远期预后的影响.在早产儿喂养方面我们常常面临这样的挑战:如何达到早产儿最佳的营养状态和理想的生长?怎样认识早产儿母乳喂养的优越性及如何保证哺乳成功?如何掌握早产儿个体化的喂养策略等等.     

Rachitic respiratory distress in small preterm infants

A syndrome of subacute respiratory distress, severe metabolic bone disease affecting the thoracic cage, and mild cholestasis occurred in 4 small preterm infants during the first three months of life and was associated with considerable morbidity. The early radiological features in the chest resembled thos of the Mikity-Wilson syndrome, with which the disorder may be confused. After spontaneous improvement in hepatic function 3 of the infants fully recovered. The fourth died of paralytic ileus. Various nutritional and absorptive abnormalities probably contribute to the pathogenesis of the bone disorder in this syndrome. The best prophylaxis might be to supplement the diet with 25-hydroxyvitamin D rather than native vitamin D.     

Very early feeding in stable small for gestational age preterm infants: a randomized clinical trial

ObjectiveTo examine the effect of initiating very early feeding on time-to-reach full feeding in stable, small for gestational age (SGA) preterm infants.MethodPreterm infants with gestational age below 37 weeks and birth weight below the 10^th percentile were randomly allocated to a very early (within 24 hours of birth) feeding regimen or delayed (after 24 hours of birth) feeding. All infants had in utero evidence of absent or reverse diastolic flow. Infants unable to start early feeding were excluded. Time-to-reach full feeding, feeding progression, and related morbidity were compared. Electrogastrography (EGG) was used to measure pre- and postprandial gastric motility on the second and seventh day after feeding initiation.ResultsSixty infants were included in the study, 30 in each group. Infants included in the very early feeding regimen achieved full enteral feeding sooner than controls (98 ± 80-157 vs. 172 ± 123-261 hours of age, respectively; p = 0.004) and were discharged home earlier (p = 0.04). No necrotizing enterocolitis (NEC) was documented in both study groups. Gastric motility was improved at day seven after feeding initiation in both study groups, with no difference between groups.ConclusionsStable SGA preterm infants on a very early feeding regimen achieved full enteral feeding and were discharged home significantly earlier than those on a delayed regimen, with no excess morbidity.     

Changing trends in feeding policies for ventilated preterm infants

In 1987 and 1994 all UK regional neonatal intensive care units were questioned about their feeding policies for the ventilated preterm infant. Between 1987 and 1994 there was an increase in the use of milk feeds (59 versus 71%), fortified breast milk (5 versus 72%) and low birthweight formula (41 versus 69%) whilst use of donor breast milk declined (56 versus 22%). Units that gave enteral feeds used significantly less parenteral nutrition ( p < 0.05). Overall there was a tendency towards greater uniformity in feeding policies.