A controlled comparison of continuous versus intermittent feeding in the treatment of infants with intestinal disease

Parker, Paul H.; Stroop, Steve; Greene, Harry L.

doi:10.1016/s0022-3476(81)80318-6

Cited by 136 publications

(43 citation statements)

References 14 publications

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“…18 Others have suggested that IBG may be more beneficial because of lower risk of precipitation into the delivery system or because of ease of administration because it does not require as much equipment; 4,5 however, this may be compensated by the nursing time required to deliver a bolus feeding. IBG, on the other hand, has been associated with increasing gastroesophageal reflux, abdominal distention, apnea, and bradycardia attributable to increased vagal stimulation and aspiration because of poor gastric motility.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Randomized Trial of Feeding Methods in Very Low Birth Weight Infants

Akintorin¹,

Kamat

Pildes

et al. 1997

Pediatrics

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ABSTRACT.Objective. To test the hypothesis that very low birth weight infants fed by continuous nasogastric gavage (CNG) would achieve full enteral feedings (100 kcal/kg/d) at an earlier postnatal age and have less feeding intolerance (FI) than infants fed by intermittent bolus gavage (IBG).Methods. Eighty infants were stratified by birth weight (700 to 1000 g and 1001 to 1250 g) and randomized into CNG or IBG feeding groups. CNG infants were comparable with IBG in birth weight, gestational age, sex, race, and day of onset of feeding (5.7 ؎ 2.1 days vs 5.6 ؎ 2.2 days, respectively). Feedings were given as undiluted Similac Special Care formula (Ross Laboratories, Columbus, OH) via a specific protocol designed for each 50 to 100 g birth weight category. Feedings were advanced isoenergetically by a maximum of 25 mL/kg/d until an endpoint of 100/kcal/kg/d for at least 48 hours was reached. An infant whose feedings were withheld for >12 hours based on predetermined criteria was considered to have an episode of FI.Results. Infants in the CNG group reached full enteral feeding at 17.1 ؎ 8.9 days compared with 15.5 ؎ 5.5 days in the IBG group; these were not statistically different. Secondary outcome variables such as days to regain birth weight (CNG, 12.6 ؎ 5 days vs IBG, 12.5 ؎ 3.7 days), days to reach discharge weight of 2040 g (CNG, 60 ؎ 13.4 days vs IBG, 62 ؎ 13.6 days), and number of episodes of FI were not significantly different between feeding methods. FI was primarily associated with birth weight <1000 g (71%) vs 1001 to 1250 g (38%).Conclusion. Feeding methods are associated with similar outcomes when feeding regimens are comparable. Pediatrics 1997;100(4). URL: http://www.pediatrics. org/cgi/content/full/100/4/e4; premature infants, feeding methods, feeding intolerance, gastric residual.

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Section: Discussionmentioning

confidence: 99%

A Prospective Randomized Trial of Feeding Methods in Very Low Birth Weight Infants

Akintorin¹,

Kamat

Pildes

et al. 1997

Pediatrics

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“…Although intermittent bolus feeding has been advocated because it is more physiological, as it mimics the hormonal profile of meal feeding, continuous feeding is still indicated for some patients due to feeding intolerance (20,58). Recently, we demonstrated, using neonatal pigs as a model for the human neonate, that orogastric continuous feeding blunts protein synthesis in skeletal muscle compared with intermittent bolus feeding (26,32).…”

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confidence: 99%

Leucine pulses enhance skeletal muscle protein synthesis during continuous feeding in neonatal pigs

Boutry

El‐Kadi

Suryawan

et al. 2013

American Journal of Physiology-Endocrinology and Metabolism

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Infants unable to maintain oral feeding can be nourished by orogastric tube. We have shown that orogastric continuous feeding restricts muscle protein synthesis compared with intermittent bolus feeding in neonatal pigs. To determine whether leucine infusion can be used to enhance protein synthesis during continuous feeding, neonatal piglets received the same amount of formula enterally by orogastric tube for 25.25 h continuously (CON) with or without LEU or intermittently by bolus every 4 h (BOL). For the CON+LEU group, leucine pulses were administered parenterally (800 μmol·kg−1·h−1) every 4 h. Insulin and glucose concentrations increased after the BOL meal and were unchanged in groups fed continuously. LEU infusion during CON feeding increased plasma leucine after the leucine pulse and decreased essential amino acids compared with CON feeding. Protein synthesis in longissimus dorsi (LD), gastrocnemius, and soleus muscles, but not liver or heart, were greater in CON+LEU and BOL than in the CON group. BOL feeding increased protein synthesis in the small intestine. Muscle S6K1 and 4E-BP1 phosphorylation and active eIF4E·eIF4G complex formation were higher in CON+LEU and BOL than in CON but AMPKα, eIF2α, and eEF2 phosphorylation were unchanged. LC3-II-to-total LC3 ratio was lower in CON+LEU and BOL than in CON, but there were no differences in atrogin-1 and MuRF-1 abundance and FoxO3 phosphorylation. In conclusion, administration of leucine pulses during continuous orogastric feeding in neonates increases muscle protein synthesis by stimulating translation initiation and may reduce protein degradation via the autophagy-lysosome, but not the ubiquitin-proteasome pathway.

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“…Continuous feeds appear to be more effective in infants with a massive loss of intestine. 11 It should be pointed out that if feeds are not provided orally, non-nutritive sucking should be encouraged to avoid oral aversion as this is often seen in these infants. The choice of feeding requires understanding of the effects of the intestine lost.…”

Section: Principles Of Medical Managementmentioning

confidence: 99%

Medical management of short gut syndrome

2010

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The provision of appropriate nutritional support is an essential part of the primary and adjunctive management of many gastrointestinal (GI) disorders in neonatology and pediatrics. Few conditions in neonatology pose as great a challenge as intestinal failure or short bowel syndrome (SBS). The latter, SBS, is a complex disorder affecting normal intestinal physiology with nutritional, metabolic and infectious consequences. It is a result of the alteration of intestinal digestion and absorption following extensive bowel resection. Medical management of SBS is a very labor-intensive problem. Nutritional support and monitoring are of paramount importance, and long-term morbidity and mortality will depend on recognition and careful management of associated complications. With the increased use of intestine or intestine-liver transplant, maintaining these infants in good 'health' to allow transplantation will go a long way in achieving good long-term outcomes.

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A controlled comparison of continuous versus intermittent feeding in the treatment of infants with intestinal disease

Cited by 136 publications

References 14 publications

A Prospective Randomized Trial of Feeding Methods in Very Low Birth Weight Infants

A Prospective Randomized Trial of Feeding Methods in Very Low Birth Weight Infants

Leucine pulses enhance skeletal muscle protein synthesis during continuous feeding in neonatal pigs

Medical management of short gut syndrome

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