Effect of early feeding on maturation of the preterm infant's small intestine

Berseth, Carol Lynn

doi:10.1016/s0022-3476(05)81969-9

Cited by 225 publications

(133 citation statements)

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“…Entre los factores reconocidos como coadyuvantes en la presentación de la enfermedad, se encuentra la alimentación entérica (7). Sin embargo, se ha visto que la alimentación entérica mínima tiene ventajas en cuanto a que mejora la motilidad y la producción enzimática, y Pérez LA, Pradilla GL, Díaz G, Bayter SM alcanza los aportes óptimos de manera más rápida, sin aumentar el riesgo de enterocolitis necrosante (14)(15)(16)(17)20).…”

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“…Sólo cuando empezaron a hacerse los estudios con esquemas de inicio temprano de alimentación entérica hipocalórica, se pudo demostrar que estos esquemas no aumentaban el riesgo de enterocolitis necrosante y sí mejoraban la producción enzimática y hormonal, y la motilidad intestinal (14,17).…”

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“…Durante un tiempo se promulgó que el postergar el inicio de la alimentación prevenía la aparición de enterocolitis necrosante (12,13). Sin embargo, se ha demostrado que la alimentación entérica mínima, ofrecida tempranamente, tiene ventajas como generar estímulo trófico, aumentar la producción enzimática y mejorar la motilidad intestinal (14,15). Además, algunos estudios han encontrado que el inicio temprano de la vía oral no aumenta el riesgo de enterocolitis (16,17).…”

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Incidencia de enterocolitis necrosante en niños prematuros alimentados precozmente

et al. 2011

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Introducción. La enterocolitis necrosante es una catástrofe multifactorial de los recién nacidos, generada por vasoconstricción visceral. Se discute el papel que juega el momento, tipo y velocidad de los incrementos de la vía oral en la patogenia de la entidad. Objetivo. Comparar la incidencia de enterocolitis necrosante y la mortalidad entre prematuros en quienes se inició alimentación entérica a las 48 horas de vida extrauterina, frente a otros en quienes se empezó al quinto día de vida. Materiales y métodos. Se llevó a cabo un ensayo clínico controlado de 239 neonatos de 750 a 1.500 gramos de peso y de 27 a 32 semanas de edad de gestación, asignados al azar, 135 a alimentación temprana y 104 a alimentación tardía con leche materna o fórmula láctea para prematuros. Se inició con un mililitro cada seis horas, para progresar en intervalos de tres horas y un incremento diario de hasta 20 ml/kg hasta llegar a 150 ml/kg al día, siempre y cuando no se observaran signos o síntomas de intolerancia a la vía oral. Resultados. Se presentaron 14 casos de enterocolitis necrosante en el grupo de alimentación temprana (10,4 %) y nueve (8,7 %) en el de alimentación tardía (RR=1,22; IC 95 % 0,49-3,20; p=0,652). Cinco (3,7 %) niños fallecieron en el grupo de alimentación temprana (IC 95 % 1,4-8,9) y ocho (7,7 %), en el de alimentación tardía (IC 95 % 3,6-15,0), sin que estas diferencias fueran significativas (RR=0,46; IC 95 % 0,12-1,60; p=0,182). Conclusión. El iniciar en forma temprana la alimentación entérica en neonatos prematuros no aumenta el riesgo de enterocolitis necrosante ni el de mortalidad y sí representa grandes ventajas para estos pacientes.Palabras clave: enterocolitis necrosante, alimentación entérica, leche humana, recién nacido. Necrotizing enterocolitis among preterm newborns with early feedingIntroduction. The development of necrotizing enterocolitis is a common and serious risk to newborns. It is caused by splanchnic bed vasoconstriction that can produce intestinal necrosis. The role of onset time, type and, speed enhancements of The factors of enteral feeding related with necrotizing enterocolitis genesis such as feeding onset, type and frequency are not well understood. Objective. The incidence of necrotizing enterocolitis and mortality among infants will be compared in infants whose enteral feeding was initiated 48 hours after birth to those whose feeding began on day 5 postpartum. Materials and methods. A controlled clinical trial was conducted among 239 newborns weighing between 750-1,500 g and a gestation age of 27-32 weeks of gestational age. The infants were randomly assigned to two groups--135 to an early feeding regime and 104 to delayed feeding. Breast milk or formula milk was used. Feeding was begun with one ml every six hours, progressing to three hour intervals and 20 ml/kg daily. This was increased to 150 ml/kg-d if the infant condition remained stable and it manifested no oral intolerance. Contribuciones de los autores:Luis Alfonso Pérez: diseño, captación de pacientes, análisis y elaboració...

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Incidencia de enterocolitis necrosante en niños prematuros alimentados precozmente

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“…Thus, many neonatologists delay the initiation of enteral feedings in favor of prolonged total parenteral nutrition. 1 Several researchers have investigated the use of minimal enteral nutrition (MEN) in preterm infants to stimulate the developing gastrointestinal tract and enhance feeding tolerance. This involves the introduction of hypocaloric, low-volume enteral nutrition that does not contain sufficient calories to sustain somatic growth.…”

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confidence: 99%

The early use of minimal enteral nutrition in extremely low birth weight newborns

et al. 2008

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Objective: To gather information regarding the efficacy of early minimal enteral nutrition on overall feeding tolerance in extremely low birth weight infants.Study Design: Prospective randomized controlled trial comparing the early use of minimal enteral nutrition in extremely low birth weight infants from day 2 to day 7 vs control infants. On day 8, feeding volume in both groups were advanced by 10 ml kg À1 day À1 until full enteral feedings were reached. Time to full feeds, number of intolerance episodes, anthropometric measurements, peak total bilirubin levels, incidence of necrotizing enterocolitis and incidence of sepsis were compared between the two groups with t-test and w 2 test.Result: Eighty-four infants were enrolled in the study but only 61 infants completed the feeding protocol. No statistically significant differences were found between the groups with regards to growth patterns, feeding tolerance, mortality, length of hospital stay and incidence of sepsis and necrotizing enterocolitis. Conclusion:Early minimal enteral nutrition use in extremely low birth weight infants did not improve feeding tolerance.

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“…Animals and humans that are exclusively fed by the parenteral route demonstrate a marked decrease in mucosal growth. 3 Although several physiologic benefits can be provided by minimal enteral feedings, 4,5 one study suggested that at least 40% of nutritional requirements need to be supplied by the enteral route before significant advantages in terms of mucosal growth are elicited. 6 It is highly likely that protein provided by the enteral route would serve as a much greater stimulus for growth than similar quantities of lipid or carbohydrate.…”

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NICHD: AAP workshop on neonatology research and training areas of research in neonatal gastroenterology

Neu

2006

J Perinatol

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Future research in neonatal and developmental gastroenterology should include inquiry well beyond finding a cure or better preventative measures against necrotizing enterocolitis. The gastrointestinal (GI) tract acts not only as a digestive-absorptive organ; it also serves major endocrine and neural functions. It encompasses a vast surface area exposed to the external environment and plays a major role in both innate and adaptive immunity. Numerous short-and long-term health benefits could be derived from a better understanding of the developing GI tract. Journal of Perinatology (2006) 26, S19-S22. doi:10.1038/sj.jp.7211424Keywords: neonate; gastointestinal tract; nutritionThe most common and life threatening gastrointestinal problem that directly concerns the neonatologist is necrotizing enterocolitis (NEC). However, successful treatment and prevention of NEC is only a small component of the overall impact that a better understanding of the developing gastroenterology (GI) tract could encompass.The purpose of this review is to suggest important areas of future research in neonatal and developmental GI that could impact both short and long term health. This review will be limited to three:(1) How can we use the GI tract safely to minimize the use of parenteral nutrition? (2) How can we harness the GI microbiota and innate immune system to ameliorate hospital-acquired infections and systemic inflammation? (3) Can we manipulate the GI tract and nutrition in early life to prevent long-term chronic illnesses such as type-1 diabetes, allergies or asthma?Using the immature GI tract and decreasing parenteral nutrition The critically ill, low birth weight infants' GI tract is either not used at all for several weeks after birth or provided with 'minimal enteral nutrition.' Considerable evidence is accumulating that this approach is far from ideal. Studies in animals and adult humans have shown that a lack of luminal nutrients results in mucosal atrophy, a lack of stimulation of trophic hormones, sepsis, increased polymorphonuclear attraction and an increased likelihood to development of the systemic inflammatory response syndrome (SIRS) 1 (Figure 1). The intestinal surface epithelium is polarized with an apical microvillus surface that usually derives most of its nutrients from the luminal rather than the basal surface. As a result of higher requirements for intestinal growth in the neonatal period, the lack of luminal nutrients may even be more important in the infant than that in the adult. It is reasonable to posit that a lack of luminal nutrients may actually underlie some of the nonintestinal pathology seen in the NICU, such as hospital-acquired sepsis and chronic lung disease.A lack of nutrients in the GI tract in the last trimester of pregnancy is an anomaly. A continuous flux of amniotic fluid through the GI tract during the last trimester of pregnancy is a component of normal physiology because the fetus swallows approximately 450 ml of amniotic fluid per day. This is suddenly interrupted at the time of prematu...

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Effect of early feeding on maturation of the preterm infant's small intestine

Cited by 225 publications

References 23 publications

Incidencia de enterocolitis necrosante en niños prematuros alimentados precozmente

Incidencia de enterocolitis necrosante en niños prematuros alimentados precozmente

The early use of minimal enteral nutrition in extremely low birth weight newborns

NICHD: AAP workshop on neonatology research and training areas of research in neonatal gastroenterology

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