The Effect of Enteral Bolus Feeding on Regional Intestinal Oxygen Saturation in Preterm Infants is Age-dependent: a Longitudinal Observational Study

Overview

Journal BMC Pediatr

Publisher Biomed Central

Specialty Pediatrics

Date 2019 Nov 6

PMID 31684920

Citations 7

Authors

Sara J Kuik

Anne G J F van Zoonen

Arend F Bos

Koenraad N J A van Braeckel

Jan B F Hulscher

Elisabeth M W Kooi

Affiliations

Soon will be listed here.

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 (rSO) 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 rSO affected cerebral oxygen saturation (rSO).

Methods: In a longitudinal observational pilot study using near-infrared spectroscopy we measured rSO and rSO 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 rSO, 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, rSO values decreased postprandially: mean (SE) 44% (10) versus 35% (7), P = .01. On Day 29, rSO values increased: 44% (11) versus 54% (7), P = .01. Infants with a PMA ≥ 32 weeks showed a rSO 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 rSO (per 10 mL/kg: OR 1.63, 95% CI, 1.02-2.59). We did not find an effect on rSO when rSO increased postprandially.

Conclusions: Our study suggests that postprandial rSO 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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References

Naulaers G, Meyns B, Miserez M, Leunens V, Van Huffel S, Casaer P . Use of tissue oxygenation index and fractional tissue oxygen extraction as non-invasive parameters for cerebral oxygenation. A validation study in piglets. Neonatology. 2007; 92(2):120-6. DOI: 10.1159/000101063. View

Bozzetti V, Paterlini G, Meroni V, DeLorenzo P, Gazzolo D, van Bel F . Evaluation of splanchnic oximetry, Doppler flow velocimetry in the superior mesenteric artery and feeding tolerance in very low birth weight IUGR and non-IUGR infants receiving bolus versus continuous enteral nutrition. BMC Pediatr. 2012; 12:106. PMC: 3447641. DOI: 10.1186/1471-2431-12-106. View

Lin P, Stoll B . Necrotising enterocolitis. Lancet. 2006; 368(9543):1271-83. DOI: 10.1016/S0140-6736(06)69525-1. View

Corvaglia L, Martini S, Battistini B, Rucci P, Aceti A, Faldella G . Bolus vs. continuous feeding: effects on splanchnic and cerebral tissue oxygenation in healthy preterm infants. Pediatr Res. 2014; 76(1):81-5. DOI: 10.1038/pr.2014.52. View

Havranek T, Rahimi M, Hall H, Armbrecht E . Feeding preterm neonates with patent ductus arteriosus (PDA): intestinal blood flow characteristics and clinical outcomes. J Matern Fetal Neonatal Med. 2014; 28(5):526-30. DOI: 10.3109/14767058.2014.923395. View

Wong F, Leung T, Austin T, Wilkinson M, Meek J, Wyatt J . Impaired autoregulation in preterm infants identified by using spatially resolved spectroscopy. Pediatrics. 2008; 121(3):e604-11. DOI: 10.1542/peds.2007-1487. View

Patel A, Lazar D, Burrin D, OBrian Smith E, Magliaro T, Stark A . Abdominal near-infrared spectroscopy measurements are lower in preterm infants at risk for necrotizing enterocolitis. Pediatr Crit Care Med. 2014; 15(8):735-41. DOI: 10.1097/PCC.0000000000000211. View

Bohlen H . Intestinal tissue PO2 and microvascular responses during glucose exposure. Am J Physiol. 1980; 238(2):H164-71. DOI: 10.1152/ajpheart.1980.238.2.H164. View

Wong F, Silas R, Hew S, Samarasinghe T, Walker A . Cerebral oxygenation is highly sensitive to blood pressure variability in sick preterm infants. PLoS One. 2012; 7(8):e43165. PMC: 3419198. DOI: 10.1371/journal.pone.0043165. View

10.

Gillam-Krakauer M, Cochran C, Slaughter J, Polavarapu S, McElroy S, Hernanz-Schulman M . Correlation of abdominal rSO2 with superior mesenteric artery velocities in preterm infants. J Perinatol. 2013; 33(8):609-12. PMC: 3655136. DOI: 10.1038/jp.2013.3. View

11.

Martini S, Aceti A, Beghetti I, Faldella G, Corvaglia L . Feed-related Splanchnic Oxygenation in Preterm Infants With Abnormal Antenatal Doppler Developing Gut Complications. J Pediatr Gastroenterol Nutr. 2017; 66(5):755-759. DOI: 10.1097/MPG.0000000000001804. View

12.

van Zoonen A, Hulzebos C, Muller Kobold A, Kooi E, Bos A, Hulscher J . Serial fecal calprotectin in the prediction of necrotizing enterocolitis in preterm neonates. J Pediatr Surg. 2018; 54(3):455-459. DOI: 10.1016/j.jpedsurg.2018.04.034. View

13.

Bembich S, Cont G, Bua J, Orlando C, Di Benedetto D, Demarini S . Bolus feeding has no effect on cerebral hemodynamics, irrespective of gestational age. J Matern Fetal Neonatal Med. 2016; 30(9):1029-1031. DOI: 10.1080/14767058.2016.1199672. View

14.

Neu J . Gastrointestinal maturation and implications for infant feeding. Early Hum Dev. 2007; 83(12):767-75. DOI: 10.1016/j.earlhumdev.2007.09.009. View

15.

Bozzetti V, Paterlini G, De Lorenzo P, Gazzolo D, Valsecchi M, Tagliabue P . Impact of Continuous vs Bolus Feeding on Splanchnic Perfusion in Very Low Birth Weight Infants: A Randomized Trial. J Pediatr. 2016; 176:86-92.e2. DOI: 10.1016/j.jpeds.2016.05.031. View

16.

Marin T, Moore J . Understanding near-infrared spectroscopy. Adv Neonatal Care. 2011; 11(6):382-8. DOI: 10.1097/ANC.0b013e3182337ebb. View

17.

Kooi E, Verhagen E, Elting J, Czosnyka M, Austin T, Wong F . Measuring cerebrovascular autoregulation in preterm infants using near-infrared spectroscopy: an overview of the literature. Expert Rev Neurother. 2017; 17(8):801-818. DOI: 10.1080/14737175.2017.1346472. View

18.

Martinussen M, Brubakk A, Vik T, Yao A . Mesenteric blood flow velocity and its relation to transitional circulatory adaptation in appropriate for gestational age preterm infants. Pediatr Res. 1996; 39(2):275-80. DOI: 10.1203/00006450-199602000-00015. View

19.

Soleymani S, Borzage M, Seri I . Hemodynamic monitoring in neonates: advances and challenges. J Perinatol. 2010; 30 Suppl:S38-45. DOI: 10.1038/jp.2010.101. View

20.

Schat T, van Zoonen A, van der Laan M, Mebius M, Bos A, Hulzebos C . Early cerebral and intestinal oxygenation in the risk assessment of necrotizing enterocolitis in preterm infants. Early Hum Dev. 2019; 131:75-80. DOI: 10.1016/j.earlhumdev.2019.03.001. View