Randomised controlled trial of trophic feeding and gut motility

McClure, Rod; Newell, S J

doi:10.1136/fn.80.1.f54

Cited by 71 publications

(48 citation statements)

References 22 publications

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“…Although the ultimate etiology of NEC remains unknown, studies have shown that certain feeding practices may be associated with decreased NEC rates. Although trophic feedings, or the provision of small volume, nutritionally insufficient feeds, have not been statistically associated with decreased NEC rates in systematic reviews, 20,21 they have been shown to stimulate gastrointestinal development [22][23][24][25] and promote gut motility 26 in premature infants. Studies have also shown a benefit to the use of human milk as the primary nutritional substrate for premature infants, with significant decreases in NEC rate associated with increased use of breast milk, both mother's own and donor.…”

Section: Discussionmentioning

confidence: 99%

Improved outcomes with a standardized feeding protocol for very low birth weight infants

et al. 2011

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Objective: The objective of this study was to evaluate the impact of a standardized enteral feeding protocol for very low birth weight (VLBW) infants on nutritional, clinical and growth outcomes.Study Design: Retrospective analysis of VLBW cohorts 9 months before and after initiation of a standardized feeding protocol consisting of 6-8 days of trophic feedings, followed by an increase of 20 ml/kg/day. The primary outcome was days to reach full enteral feeds defined as 160 ml/ kg/day. Secondary outcomes included rates of necrotizing enterocolitis and culture-proven sepsis, days of parenteral nutrition and growth end points.Result: Data were analyzed on 147 VLBW infants who received enteral feedings, 83 before ('Before') and 64 subsequent to ('After') feeding protocol initiation. Extremely low birth weight (ELBW) infants in the After group attained enteral volumes of 120 ml/kg/day (43.9 days Before vs 32.8 days After, P ¼ 0.02) and 160 ml/kg/day (48.5 days Before vs 35.8 days After, P ¼ 0.02) significantly faster and received significantly fewer days of parenteral nutrition (46.2 days Before vs 31.3 days After, P ¼ 0.01). Necrotizing enterocolitis decreased in the After group among VLBW (15/83, 18% Before vs 2/64, 3% After, P ¼ 0.005) and ELBW infants (11/31, 35% Before vs 2/26, 8% After, P ¼ 0.01). Late-onset sepsis decreased significantly in the After group (26/83, 31% Before vs 6/64, 9% After, P ¼ 0.001). Excluding those with weight <3rd percentile at birth, the proportion with weight <3rd percentile at discharge decreased significantly after protocol initiation (35% Before vs 17% After, P ¼ 0.03).Conclusion: These data suggest that implementation of a standardized feeding protocol for VLBW infants results in earlier successful enteral feeding without increased rates of major morbidities.

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Section: Discussionmentioning

confidence: 99%

Improved outcomes with a standardized feeding protocol for very low birth weight infants

et al. 2011

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“…Furthermore, early trophic feeds do not increase susceptibility to developing NEC. However, studies have not yet clearly delineated the best feeding strategies for premature infants [147] .…”

Section: Trophic Feedsmentioning

confidence: 99%

“…Trophic feeds improve the activity of digestive enzymes, enhance the release of digestive hormones and increase intestinal blood flow and digestive motility in premature infants [147] . In addition, infants given early trophic feeds seem to have better feeding tolerance, improved growth, reduced period of hospitalization and decreased likelihood of sepsis compared with infants who are not [147] . Furthermore, early trophic feeds do not increase susceptibility to developing NEC.…”

Section: Trophic Feedsmentioning

confidence: 99%

Necrotizing enterocolitis: A multifactorial disease with no cure

Schnabl

Aerde²,

Thomson³

et al. 2008

WJG

161

120

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INTRODUCTIONNecrotizing enterocolitis (NEC) is an inflammatory bowel disease of neonates and remains one of the most common gastrointestinal emergencies in newborn infants [1] . Onset of NEC is often within the first three months of life and neonates who are of extremely low birth weight (< 1000 g) and under 28 wk gestation are the most susceptible [2] . Full term neonates account for 10% of all NEC cases while premature infants account for 90% [3] . With an incidence rate of 1%-5% for all newborns admitted to the NICU [1] , a prevalence of 7%-14% of very low birth weight infants (VLBW, 500-1500 g) [4] and a mortality rate approaching 20%-50% [5] , NEC continues to represent a significant clinical problem. In Canada, the incidence rate is 1.8 per 100 live births with a prevalence of 7% of VLBW infants [1] . Advances in obstetric and neonatal care have improved survival rates for smaller, more immature infants, and as more VLBW preterm infants survive the neonatal period, the population at risk for NEC increases [1] .No consistent association between sex, race, and rates of NEC has been identified. However, male VLBW infants and black infants are at greater risk of death [6] . Due to inadequate treatments and no effective preventative strategy, an estimated 20%-40% of babies with NEC require surgery [1] and 10%-30% experience significant morbidity including neurodevelopmental impairment, vision and hearing impairment, failure to thrive, feeding abnormalities, diarrhea, bowel obstruction, and short bowel syndrome [1,2,7] . The case fatality rate with surgical intervention is as high as 50% [1] . NEC is also a financial burden to the health care system with yearly hospital charges reported to be as high as $6.5 million in the US [8] . Thus, NEC continues to be an important health issue for preterm neonates. DIAGNOSIS Clinical signs and symptomsThe onset of NEC can occur suddenly within a few AbstractNecrotizing enterocolitis is an inflammatory bowel disease of neonates with significant morbidity and mortality in preterm infants. Due to the multifactorial nature of the disease and limitations in disease models, early diagnosis remains challenging and the pathogenesis elusive. Although preterm birth, hypoxic-ischemic events, formula feeding, and abnormal bacteria colonization are established risk factors, the role of genetics and vasoactive/inflammatory mediators is unclear. Consequently, treatments do not target the specific underlying disease processes and are symptomatic and surgically invasive. Breast-feeding is the most effective preventative measure. Recent advances in the prevention of necrotizing enterocolitis have focused on bioactive nutrients and trophic factors in human milk. Development of new disease models including the aspect of prematurity that consistently predisposes neonates to the disease with multiple risk factors will improve our understanding of the pathogenesis and lead to discovery of innovative therapeutics.

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“…Among the advantages of minimal enteral nutrition are the promotion of intestinal motility, better food tolerance, decrease in the incidence of sepsis and induction of lactase activity. 65 These advantages have not been totally confirmed after systematic literature review. 66 Most preterm infants born at less than 34 weeks of gestation are fed through a nasogastric or orogastric tube due to their difficulty in synchronizing sucking, swallowing, and breathing.…”

Section: Lipid Requirements Of Preterm Infantsmentioning

confidence: 92%

Dilemas nutricionais no pré-termo extremo e repercussões na infância, adolescência e vida adulta

Camelo¹,

Martinez²

2005

J. Pediatr. (Rio J.)

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Suggested citation: Camelo Jr. JS, Martinez FE. Nutritional dilemmas in extremely low birth weight infants and their effects on childhood, adolescence and adulthood. J Pediatr (Rio J). 2005;81(1 Suppl):S33-S42. AbstractObjective: To review the recent medical literature on nutrition of extremely low birth weight infants, focusing on nutritional dilemmas and their effects on childhood, adolescence and adulthood.Sources of data: An extensive review of the related literature was performed using MEDLINE, the Cochrane Database of Systematic Reviews and the Best Evidence database. Summary of the findings:There is a growing body of evidence that early nutritional practices may affect shortterm growth and development outcome. In addition, these practices may play a role in determining adult health and disease. There is still much to be learned about safe and efficacious nutrient administration in preterm infants; about techniques to assess the effect of different nutritional strategies; and about the long-term effects of these regimens on development outcome, growth and disease.Conclusion: Despite recent progress in neonatal nutrition, there is a lack of basic and clinical research to better define the nutritional requirements of preterm infants and the best way to meet these requirements, avoiding longterm undesirable consequences.J Pediatr (Rio J). 2005;81(1 Suppl):S33-S42: Nutrition, human milk, prematurity, parenteral nutrition, enteral nutrition, nutritional programming.

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Randomised controlled trial of trophic feeding and gut motility

Cited by 71 publications

References 22 publications

Improved outcomes with a standardized feeding protocol for very low birth weight infants

Improved outcomes with a standardized feeding protocol for very low birth weight infants

Necrotizing enterocolitis: A multifactorial disease with no cure

Dilemas nutricionais no pré-termo extremo e repercussões na infância, adolescência e vida adulta

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