Feeding intolerance in preterm infants. How to understand the warning signs

Abstract

It is essential to start enteral nutrition early to preterm infants by giving small amounts of milk (preferably human milk) to ensure that metabolic homeostasis is kept stable and to limit postnatal growth retardation. Increasing feeding volumes to reach "full enteral feeding" is limited by individual feeding tolerance. Feeding intolerance is extremely common in premature infants. The most frequent signs of a suspect feeding intolerance are the presence of gastric residuals, abdominal distension and the onset of crises of apnea/bradycardia. Gastric residuals are probably a benign consequence of delayed gut maturation and motility in VLBW infants and there are no established normal standards. When gastric aspirates occur isolated they should not immediately induce the neonatologist to withhold feeding. Gastric residual becomes more important when accompanied by other warning signs, such as bilious vomiting, abdominal distension, abdominal wall erythema or ecchymosis, gross or occult blood in the stool, apnoea, bradycardia and temperature instability. Nutrition protocols in preterm infants must take caution when starting and increasing enteral feeding, and pay proper, but not excessive, attention to early signs of food intolerance.

Glycerin Enemas and Suppositories in Premature Infants: A Meta-analysis

“…This outcome was reported in the 2 glycerin suppository trials but was variably defined. 7,31,32 In Khadr et al, 31 there were no differences between groups in terms of incidence of abdominal distension .2 cm, number of bilious residuals, number of feedings withheld, number of feedings reduced or not increased, and percentage of gastric residuals compared with total enteral feeding volume. These outcomes were all measured within the first 10 days of life.…”

“…[1][2][3][4][5][6][7][8] These patients often receive glycerin enemas or suppositories to stimulate the passage of meconium and improve feeding tolerance. 9 This practice is based on the observation that many premature infants experience significant delays in the passage of meconium, which is more viscous than normal stool.…”

Association of metabolic acidosis with bovine milk-based human milk fortifiers

“…1 Human milk contains anti-infective immunomodulators, [2][3][4] and is associated with lower rates of necrotizing enterocolitis, [3][4][5][6][7] improved feeding tolerance 3,8 and improved neurodevelopmental outcomes later in life. 9,10 Donor breast milk is even encouraged as a feeding alternative for high-risk infants whose mothers cannot or do not provide their own milk.…”

Caffeine impairs gastrointestinal function in newborn rats

“…Yet, the gastrointestinal effects of caffeine have not been studied in neonates. This represents a significant knowledge gap since feeding intolerance ranks as one of the most common clinical issues for preterm infants (28,29), the target population for caffeine administration.…”