The effect of enteral bolus feeding on regional intestinal oxygen saturation in preterm infants is age-dependent: a longitudinal observational study

Abstract

BackgroundThe 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 (rintSO2) 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 rintSO2 affected cerebral oxygen saturation (rcSO2).MethodsIn a longitudinal observational pilot study using near-infrared spectroscopy we measured rintSO2 and rcSO2 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 rcSO2, we also used logistic regression analyses.ResultsWe included 29 infants: median (range) gestational age 28.1 weeks (25.1–30.7) and birth weight 1025 g (580–1495). On Day 5, rintSO2 values decreased postprandially: mean (SE) 44% (10) versus 35% (7), P = .01. On Day 29, rintSO2 values increased: 44% (11) versus 54% (7), P = .01. Infants with a PMA ≥ 32 weeks showed a rintSO2 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 rintSO2 (per 10 mL/kg: OR 1.63, 95% CI, 1.02–2.59). We did not find an effect on rcSO2 when rintSO2 increased postprandially.ConclusionsOur study suggests that postprandial rintSO2 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 registrationFor this prospective longitudinal pilot study we derived patients from a larger observational cohort study: CALIFORNIA-Trial, Dutch Trial Registry NTR4153.

Near-infrared spectroscopy as a diagnostic tool for necrotizing enterocolitis in preterm infants

“…Recently, it was also reported that r s SO 2 did not change after bolus feeds in preterm infants during the first weeks after birth. 20 We believe therefore that the impact of feeding status on our findings is limited. A fourth limitation relates to the CoVAR measurement.…”

“…This was, however, not found in a recent study of ours in relatively healthy preterm infants during the first weeks after birth. 20 A better explanation relates to peristaltic movement of the intestines. Variability may increase as different parts of the moving intestines will be measured with potentially different r s SO 2 values.…”

Remote ischaemic conditioning in necrotising enterocolitis: a phase I feasibility and safety study

“…In addition, persistent ductus arteriosus can lead to bowel hypoperfusion25 and is also associated with NEC 26. Previous studies on splanchnic circulation using near-infrared spectroscopy showed that regional oxygen saturation is lower, especially after feeds in babies who later developed NEC 22 27. Lastly, at the disease onset, local bowel inflammation is associated with impaired microcirculation which leads to bowel wall ischaemia and eventually transmural necrosis 28.…”

Passive Smoking is Associated with Risk of Early Onset of Cardiac Dysfunction

“…Hence FF is more stressful in infants and this can explain the DD which is increased with SHS versus the breastfed group of infants who showed no impairment in their diastolic function in this study. Also FF infants usually overfeed and this bolus feeding interferes with the rise in the oxygen saturation (Kuik et al, 2019). The absence of a mechanism for satiety in FF vs breastfed who have better control their intake (DiSantis et al, 2011) may play an role in increasing the pulmonary resistance and pressure on the lungs and decreasing the heart rate in FF infants.…”