Enteral Feeding In Preterm Infants Research Articles

Working group reports: evaluation of the evidence to support practice guidelines for nutritional care of preterm infants—the Pre-B Project1–4

ABSTRACTThe “Evaluation of the Evidence to Support Practice Guidelines for the Nutritional Care of Preterm Infants: The Pre-B Project” is the first phase in a process to present the current state of knowledge and to support the development of evidence-informed guidance for the nutritional care of preterm and high-risk newborn infants. The future systematic reviews that will ultimately provide the underpinning for guideline development will be conducted by the Academy of Nutrition and Dietetics’ Evidence Analysis Library (EAL). To accomplish the objectives of this first phase, the Pre-B Project organizers established 4 working groups (WGs) to address the following themes: 1) nutrient specifications for preterm infants, 2) clinical and practical issues in enteral feeding of preterm infants, 3) gastrointestinal and surgical issues, and 4) current standards of infant feeding. Each WG was asked to 1) develop a series of topics relevant to their respective themes, 2) identify questions for which there is sufficient evidence to support a systematic review process conducted by the EAL, and 3) develop a research agenda to address priority gaps in our understanding of the role of nutrition in health and development of preterm/neonatal intensive care unit infants. This article is a summary of the reports from the 4 Pre-B WGs.

Variation of weight for age Z scores in preterm infants with extrauterine growth restriction

Objective To understand variation of weight for age Z scores in premature infants with extrauterine growth restriction(EUGR). Methods Retrospective analysis was adopted with the data of very-low-gestational age(VLGA) preterm infants who met with the following criteria: admitted to Neonatal Medical Center of Huai'an Maternity and Child Healthcare Hospital from January 2011 to December 2013, gestational age <32 weeks, more than 4 weeks of hospital stay and survived when discharged.All VLGA premature infants were divided into non-EUGR group and EUGR group according to whether the standard weight on hospital discharge was below the 10th percentile of body weight at corrected age.The weight for age Z scores of preterm infants were calculated at each time point.The differences and trends between 2 groups were compared.The receiver operating characteristic (ROC) curve in diagnosing EUGR by weight for age Z scores was drawn. Results A total of 177 VLGA premature infants were enrolled, and among them there were was 104 cases of EUGR and the incidence amounted to 58.8%.The weight for age Z scores curve of EUGR group was under that of all preterm infants, and the curve of non-EUGR group was above that of all preterm infants.The weight for age Z scores of all preterm infants and EUGR group showed overall downward trend along with prolonged hospitalization.However, the weight for age Z scores of non-EUGR group did not change significantly at each week point except for the first week.The weight for age Z scores of EUGR group was lower than that of non-EUGR group at birth (-0.84±0.39 vs -0.31±0.41), the first week after birth (-1.19±0.36 vs -0.74±0.40), the second week after birth (-1.17±0.36 vs -0.68±0.40), the third week after birth (-1.23±0.34 vs -0.64±0.39), the fourth week after birth (-1.35±0.41 vs -0.65±0.42), the fifth week after birth (-1.45±0.41 vs -0.56±0.38), the sixth week (-1.54±0.49 vs -0.70±0.36) and on discharge time (-1.72±0.38 vs -0.67±0.42). The difference at each week point was statistically significant (all P=0.000). The weight for age Z scores on discharge were negatively correlated with start time of enteral feeding in preterm infants (r=-0.271, P<0.05), time of parenteral nutrition up to 418 kJ/(kg·d)(r=-0.388, P<0.05), time of full enteral feeding (r=-0.332, P<0.05), amino cumulative dose (r=-0.298, P<0.05) and fat milk cumulative dose (r=-2.221, P<0.05). Area under the curve at each week point of the weight for age Z scores predicting the EUGR gradually increased along with prolonged hospitalization.There was a statistical significance in the weight for age Z scores value at each week point on the diagnosis of EUGR(P=0.000). There was a high sensitivity and specificity at each week point. Conclusions Dynamic monitoring weight of age Z scores of the premature infants can show the nutrition and growth trend, and may be a risk warning of the preterm infants suffering from EUGR. Key words: Extrauterine growth restriction; Weight for age Z score; Infant, premature

Early gradual feeding with bovine colostrum improves gut function and NEC resistance relative to infant formula in preterm pigs.

It is unclear when and how to start enteral feeding for preterm infants when mother's milk is not available. We hypothesized that early and slow advancement with either formula or bovine colostrum stimulates gut maturation and prevents necrotizing enterocolitis (NEC) in preterm pigs, used as models for preterm infants. Pigs were given either total parenteral nutrition (TPN, n = 14) or slowly advancing volumes (16-64 ml·kg(-1)·day(-1)) of preterm infant formula (IF, n = 15) or bovine colostrum (BC, n = 13), both given as adjunct to parenteral nutrition. On day 5, both enteral diets increased intestinal mass (27 ± 1 vs. 22 ± 1 g/kg) and glucagon-like peptide 2 release, relative to TPN (P < 0.05). The incidence of mild NEC lesions was higher in IF than BC and TPN pigs (60 vs. 0 and 15%, respectively, P < 0.05). Only the IF pigs showed reduced gastric emptying and gastric inhibitory polypeptide release, and increased tissue proinflammatory cytokine levels (IL-1β and IL-8, P < 0.05) and expression of immune-related genes (AOAH, LBP, CXCL10, TLR2), relative to TPN. The IF pigs also showed reduced intestinal villus-to-crypt ratio, lactose digestion, and some plasma amino acids (Arg, Cit, Gln, Tyr, Val), and higher intestinal permeability, compared with BC pigs (all P < 0.05). Colonic microbiota analyses showed limited differences among groups. Early feeding with formula induces intestinal dysfunction whereas bovine colostrum supports gut maturation when mother's milk is absent during the first week after preterm birth. A diet-dependent feeding guideline may be required for newborn preterm infants.

Contemporary views concerning the necessity, age of indication and duration of iron administration to prevent deficiency and to treat iron-deficiency anemia in infants

Nowadays deficiency of micronutrients leading to the development of serious disorders in the human organism remains an important problem to be solved in the world. Anemia is considered to be one of such problems which is an indicator of the quality of diet and the sate of human heath. About 70-80% cases of diagnosed anemia are connected with iron deficiency. Iron-deficiency anemia may occur in any place, season of the year and age. Although pregnant women and newborns, especially preterm ones are the most susceptible to the development of anemia. The article specifies explanations concerning the importance of iron intake by the fetus in the III trimester of pregnancy and the importance of iron effect upon an adequate development of fetus and babies in the first 2 years of life. Perinatal risk factors are indicated which cause 20% of development of iron-deficiency conditions and pathophysiological reasons of a negative influence of these conditions on the CNS. Using the findings of the unified protocol project “Enteral Feeding of Preterm Infants” and results of the studies investigating the influence of iron preparations upon the development of infants, CNS state, hematological status, the age to indicate iron preparations, daily doses and duration of their administration are discussed.Attention is focused on the advantages to administer oral forms of ferric iron (drops, syrup “Maltofer”) for infants. The method to calculate a daily amount of iron preparation is demonstrated individually for every child, being aware of a therapeutic dose of an elementary iron in 1 ml of preparation. The analysis of the studies existed from 1960-2010 enables to conclude that administration of iron preparations in newborns and infants of various gestational age improve the indices of iron hematological status and reduce the frequency of development of iron deficiency and iron-deficiency anemia. Till now there is a necessity to conduct randomized controlled trials with the aim to get essential evidence concerning the consequences of iron preparation effect upon the development of the nervous system or occurrence of unfavourable effects in preterm newborns, especially in infants with very low body weight at birth.The optimum dose, the term of the beginning and duration of the administration of ferric iron use indicated for intravenous injection are defined: gestational age of a baby, hematological indices (the level of hemoglobin, serum ferritin, mean corpuscular volume), the aim achieved (prevention of iron deficiency or treatment of iron-deficiency anemia).

Preterm newborn readiness for oral feeding: systematic review and meta-analysis.

To identify and systematize the main studies on the transition from enteral to oral feeding in preterm infants. Articles that describe the transition from oral to enteral feeding in preterm infants were located in MEDLINE, LILACS, and SciELO databases. Original studies, with available abstract, published in the last 10 years were included. Analysis of the methodology and the main results of the studies, and meta-analysis of the effects of sensory-motor-oral stimulation at the time of transition to full oral feeding and duration of hospitalization were conducted. Twenty-nine national and international publications were considered. Most studies were clinical trials (44.8%) and did not use rating scales to start the transition process (82.7%). In the meta-analysis, positive effect of stimulation of the sensory-motor-oral system was observed with respect to the transition time to oral diet (p=0.0000), but not in relation to the length of hospital stay (p=0.09). However, heterogeneity between studies was found both in the analysis of the transition time to full oral feeding (I2=93.98) and in the length of hospital stay (I2=82.30). The transition to oral feeding is an important moment, and various physical and clinical characteristics of preterm infants have been used to describe this process. Despite the impossibility of generalizing the results due to the heterogeneity of the studies, we have noted the importance of strategies for stimulation of sensory-motor-oral system to decrease the period of transition to full oral feeding system.

PO-0471 Neonatal Arousal And Home-cage Activity Are Feeding-dependent In Preterm Pi

Background and aims Preterm infants exhibit delayed neonatal arousal and impaired motor function. Impaired neuromuscular development, probably interacting with gut and metabolic dysfunctions, may explain this. Using preterm pigs as models, we hypothesised that early initiation of enteral feeding stimulates both gut growth and neonatal arousal and physical activity. Methods Experiment 1: Caesarean-delivered preterm and term pigs were fed parenteral nutrition (PN) or PN plus enteral bovine colostrum (BC) for five days. Other preterm pigs were fed PN with or without BC or formula for five days (Experiment 2), or increasing doses of BC, formula or human milk (HM) for 10 days (Experiment 3). Daily energy intake was matched among the groups in each experiment and home cage activity (HCA) was recorded by continuous camera surveillance. Results Prematurity at birth delayed eye lid opening, first stand and walk, and reduced relative intestinal weight and HCA (Experiment 1, all p Conclusions Prematurity decreased physical activity and relative gut weight within the first week after birth. Small volumes of enteral feeds increased the activity. This may result from general metabolic effects of enteral feeding but could also reflect a direct diet-dependent, gut-neuromuscular maturation in preterm neonates fed enterally. The results support the importance of early enteral feeding of preterm infants with adequate amounts of an optimal diet.

Bifidobacterium and enteral feeding in preterm infants: Cluster‐randomized trial

BackgroundThis study evaluated the benefit of Bifidobacterium bifidum OLB6378 (B. bifidum) in very low-birthweight (VLBW) infants (birthweight <1500 g) for the acceleration of enteral feeding.MethodsA cluster-randomized, double-blind, placebo-controlled trial was conducted in 19 hospitals, divided into two groups: the B group (n = 10 hospitals; B. bifidum given to infants within 48 h of birth) and the P group (n = 9 hospitals; infants received a placebo). The primary outcome was establishment of enteral feeding after birth, defined as the postnatal day at which enteral feeding exceeded 100 mL/(kg/day). Secondary outcomes were defined as incidence of morbidity and somatic growth before discharge.ResultsOverall, 283 VLBW infants were enrolled in the study: B group, n = 153; and P group, n = 130. Enteral feeding was established within 21 days after birth in 233 infants, of whom 119 received B. bifidum and 114 received placebo until their bodyweight reached 2000 g. Enteral feeding was established significantly earlier in the B group, at 11.0 ± 3.6 days versus 12.1 ± 3.8days in P group (P < 0.05). Infant growth during the stay in the neonatal intensive care unit was not different between groups, but the incidence of late-onset sepsis among all enrolled infants was significantly lower in the B group (3.9%, 6/153) than in the P group (10.0%, 13/130; P < 0.05). No differences were observed in the incidence of other adverse outcomes including mortality.ConclusionsB. bifidum in VLBW infants accelerated the establishment of enteral feeding after birth without increasing the incidence of adverse effects.

Splanchnic Tissue Oxygenation for Predicting Feeding Tolerance in Preterm Infants.

Feeding intolerance is very frequent in preterm infants, and the development of an early effective biomarker for its prediction could be useful for carrying out a proper feeding strategy. Our aim was to evaluate if the measurement of splanchnic regional oxygenation (rSO2S) and splanchnic fractional oxygen extraction ratio (FOES) using near-infrared spectroscopy (NIRS) is correlated with the time needed to achieve full enteral feeding and if it can predict the development of feeding intolerance. We measured rSO2S and FOES in preterm infants 25 ± 0 to 31 ± 6 weeks of gestational age at 24-72 hours of life during continuous enteral feeding. Linear regression analysis did not evidence any relationship between rSO2S and FOES and the time for achievement of full enteral feeding. Multivariate logistic regression analysis showed that birth weight <1000 g (relative risk [RR], 4.5; 95% confidence interval [CI], 1.23-16.45) and patent ductus arteriosus occurrence (RR, 9.3; 95% CI, 1.31-66.06) increased the risk of developing feeding intolerance in our population. Splanchnic oxygenation and oxygen extraction measured in the first days of life are not correlated with the time needed to achieve full enteral feeding in preterm infants receiving continuous enteral nutrition.

Randomized Controlled Trial: Impact of Glycerin Suppositories on Time to Full Feeds in Preterm Infants

Background: Feed intolerance delays achievement of enteral feeding in preterm infants. Parenteral nutrition is associated with cholestasis and increased risk of sepsis. Glycerin suppositories have been used to promote gastrointestinal motility and feed tolerance. Objectives: To investigate whether daily glycerin suppositories (a) reduce the time to full enteral feeding in infants born at <32 weeks’ gestation, and (b) influence feed tolerance, incidence of sepsis or necrotizing enterocolitis, duration of oxygen requirement, growth or age at discharge. Methods: Design – prospective open randomized controlled trial; study population – preterm infants stratified into 2 subgroups, 24–27⁺⁶ weeks (24–27 weeks + 6 days) and 28–31⁺⁶ weeks; intervention – daily glycerin suppository for 10 days from 24 h of age, 250 mg (24–27⁺⁶ weeks subgroup) or 500 mg (two 250-mg suppositories; 28–31⁺⁶ weeks subgroup); controls – no intervention. The same feeding protocol and departmental guidelines for other aspects of neonatal intensive care were used in all subjects. Analysis was by intention to treat. Results: 54 babies were recruited (31 males), 29 randomized to receive suppositories; 48 achieved full enteral feeds. The median (range) time to full feeds was 1.6 days shorter in intervention group babies than controls, but not statistically significant: 7.4 (4.6–30.9) days versus 9.0 (4.4–13.3) days (p = 0.780; 95% confidence interval: –1.917, 2.166). No significant differences were observed in secondary outcomes. Intervention group babies passed their first stool earlier than controls (median: day 2 vs. day 4; p = 0.016). Conclusion: Regular glycerin suppositories did not reduce the time to full enteral feeds in infants born at <32 weeks’ gestation in our setting.

1026 Necrotizing Enterocolitis in Preterm Infants on Different Feeding Protocol

Background and aims: Feeding with human milk (HM) is in correlation with many useful effects and represents key component in strategy of enteral feeding of preterm infants. Objective of this research was to determine incidence of necrotizing enterocolitis (NEC) in structure of morbidity and relative risk (RR) of acquiring NEC in preterm infants fed with fortified human milk (FHM) and preterm formula (PF) respectively. Methods: Total of 100 preterm infants of gestational age less than 34 weeks were included in this prospective analysis. Subjects were divided in two groups: group I (n=50) fed with FHM (FM 85 Nestle) and group II (n=50) fed with PF (preNAN Nestle) in case where lactation wasn't established, for 4 weeks. NEC was diagnosed if presence of intestinal pneumatosis on X-ray was verified (Bell's stage II and III). Results: Initially, examined groups did not differ considering the gestational age, Apgar score and antropometric parameters at birth. Subjects fed with FHM reached full enteral feeding earlier compared to PF fed group (p< 0,05). Incidence of NEC in FHM fed group was 2%, and in PF fed group 6% (p>0,05). In FHM fed group RR=0,33, 95% CI (0,36-3,097), which means that risk of acquiring NEC is 33% less compared to risk in PF fed group. Conclusion: There is no statistically significant difference between these two groups in incidence of NEC, but RR indicates a smaller risk of NEC in FHM fed group.

Prebiotics Improve Gastric Motility and Gastric Electrical Activity in Preterm Newborns

The aim of this double-blind, randomized, placebo-controlled study was to evaluate the effect of a prebiotic mixture on gastric motility in preterm newborns. After a feeding period of 15 days, gastric electrical activity was measured by electrogastrography, and the gastric emptying time was studied by ultrasound technique. No difference was seen in the daily increase of body weight, and no adverse events have been reported. The percentage of time in which propagation was detected in the electrogastrography signal was twice in newborns receiving formula with prebiotics with respect to placebo, and the gastric half-emptying time was 30% faster in the prebiotic group than the placebo group. Prebiotic oligosaccharides can modulate the electrical activity and the gastric emptying and may improve the intestinal tolerance of enteral feeding in preterm infants.

Oral supplementation with probiotics in very-low-birth-weight preterm infants: a randomized, double-blind, placebo-controlled trial

Background: Although recent reports suggest that supplementation with probiotics may enhance intestinal function in premature infants, the mechanisms are unclear, and questions remain regarding the safety and efficacy of probiotics in extremely low-birth-weight infants.Objective: The objective was to evaluate the efficacy of probiotics on the digestive tolerance to enteral feeding in preterm infants born with a very low or extremely low birth weight.Design: In a bicentric, double-blind, randomized controlled clinical trial that was stratified for center and birth weight, 45 infants received enteral probiotics (Bifidobacterium longum BB536 and Lactobacillus rhamnosus GG; BB536-LGG) and 49 received placebo. The primary endpoint was the percentage of infants receiving >50% of their nutritional needs via enteral feeding on the 14th day of life. A triangular test was used to perform sequential analysis.Results: The trial was discontinued after the fourth sequential analysis concluded a lack of effect. The primary endpoint was not significantly different between the probiotic (57.8%) and placebo (57.1%) groups (P = 0.95). However, in infants who weighed >1000 g, probiotic supplementation was associated with a shortening in the time to reach full enteral feeding (P = 0.04). Other than colonization by the probiotic strains, no alteration in the composition of intestinal microbiota or changes in the fecal excretion of calprotectin was observed. No colonization by probiotic strains was detected in infants who weighed ≤1000 g, presumably because of more frequent suspensions of enteral feeding, more courses of antibiotic treatment, or both.Conclusions: Supplementation with BB536-LGG may not improve the gastrointestinal tolerance to enteral feeding in very-low-birth-weight infants but may improve gastrointestinal tolerance in infants weighing >1000 g. This trial was registered at clinicaltrials.gov as NCT 00290576.

High-Dose Oral Erythromycin Decreased the Incidence of Parenteral Nutrition-Associated Cholestasis in Preterm Infants

Background & Aims: Feeding intolerance because of functional gastrointestinal dysmotility and parenteral nutrition-associated cholestasis (PNAC) are common problems in preterm, very-low-birth-weight (VLBW) infants. This double-blind, randomized, placebo-controlled study aimed to assess the effectiveness of “high-dose” oral erythromycin as a prokinetic agent in decreasing the incidence of PNAC. Two secondary end points, including the time to achieve full enteral feeding and the duration of parenteral nutrition, were also evaluated. Methods: Infants consecutively admitted to the neonatal unit were randomized to receive erythromycin (12.5 mg/kg/dose every 6 hours for 14 days) or an equivalent volume of normal saline (placebo) if they attained less than half the total daily fluid intake (<75 mL/kg/day) as milk feeds on day 14 of life. Results: Of 182 VLBW infants enrolled, 91 received erythromycin. The incidence of PNAC was significantly lower in erythromycin-treated infants (18/91) compared with placebo infants (37/91; P = .003). Treated infants achieved full enteral nutrition significantly earlier (mean, 10.1; SE, 1.7 days; P < .001), and the duration of parenteral nutrition was also significantly decreased by 10 days (P < .001). Importantly, fewer infants receiving erythromycin had 2 or more episodes of septicemia (n = 4) compared with placebo patients (n = 13, P = .03). No serious adverse effect was associated with erythromycin treatment. Conclusions: High-dose oral erythromycin can be considered as a rescue measure for VLBW infants who fail to establish adequate enteral nutrition and in whom anatomically obstructive pathologies of the gastrointestinal tract have been excluded.

38 Opinions in Scottish Neonatal Units About Enteral Feeding of Pre-Term Infants

Background: Enteral feeding of preterm and low birth weight infants is a contentious issue. There is uncertainty about the optimum approach. Concerns relate to the competing, serious potential risks of necrotising enterocolitis and catheter-related infection associated with different feeding methods. Evidence on which clinicians can base clinical practice is weak. Research studies have been small and results conflicting. Large randomised trials are needed. To ensure that trial interventions are relevant and acceptable to clinicians and that results are generalisable, it is important to be informed about ranges of opinion influencing current practice.Aim: To document current opinion and reported practice of neonatologists in Scotland with respect to enteral feeding of preterm and low birth weight infants.Methods: Senior clinicians from 15 Scottish neonatal units participated in a survey of opinions and policies about feeding of preterm (≤32 weeks) and low birth weight (≤ 1500g) babies. A single researcher using face-to-face interviews and semi-structured questionnaires conducted the survey.Results: 8(53%) units have written guidelines for initiation of feeds, 5(33%) for the rate of increase and 3(20%) for the discontinuation of feeds. All aim to introduce maternal breast milk on day 1 or 2 of life. None delay milk introduction for >48hours in the absence of specific contraindications. If breast milk is unavailable, 1(7%) unit uses donor milk, 6(40%) use preterm formula, 5(33%) term formula and 3(20%) hydrolysed protein formula. Preferred volumes for initiating feeds are variable, ranging from 0.5ml every 6–12 hours to 1ml/hour. Criteria for discontinuing feeds based on gastric aspirates are inconsistent between units. Gastric residual volumes considered “large” vary from ≥25% of the hourly feed volume to ≥2 hourly feed volumes. Decisions to withold feeds are made by a variety of staff in most units. One clinician indicated that consultants in that unit usually make such decisions, another that decisions are most often made by nurses.Conclusion: There is wide variation in opinion among neonatologists in Scotland and variable use of feeding guidelines. This probably reflects clinical uncertainty and is likely to lead to similar disparity in practice. Such differences may influence important outcomes such as necrotising enterocolitis and line- or parenteral nutrition-related complications. There is an urgent need for large, well-designed studies to define optimum feeding strategies.

Prediction of early tolerance to enteral feeding by measurement of superior mesenteric artery blood flow velocity: appropriate- versus small-for-gestational-age preterm infants.

To evaluate whether serial Doppler measurements of superior mesenteric artery blood flow velocity could predict early tolerance to enteral feeding in preterm infants. In a prospective study, 54 healthy preterm neonates were assigned to one of the following groups: neonates with birthweight appropriate for gestational age (group 1), neonates small for gestational age without (group 2) and with prenatal haemodynamic disturbances (group 3). We studied Doppler blood flow velocity and resistance index before and after the first feed. Contrary to patients of group 3, infants in groups 1 and 2 showed a significant increase in blood flow velocity and a significant decrease in resistance index from the preprandial values after the first feed. At each postprandial time, we found significant differences in all velocity and resistance measurements between patients of group 3 and patients of both groups 1 and 2. In all patients, we found that the value of mean velocity measured 30 min after the first feed was the most predictive of early feed tolerance, with 95% sensitivity and 94% specificity when mean velocity >0.38 m/s. Small-for-gestational-age preterm infants with prenatal haemodynamic disturbances have an unusual intestinal haemodynamic response to the first feed. In the whole group of preterm infants, the value of mean velocity measured 30 min after the first feed is a good tool for the clinician in predicting early enteral feeding.

Prediction of early tolerance to enteral feeding by measurement of superior mesenteric artery blood flow velocity: appropriate- versus small-for-gestational-age preterm infants

Aim: To evaluate whether serial Doppler measurements of superior mesenteric artery blood flow velocity could predict early tolerance to enteral feeding in preterm infants. Methods: In a prospective study, 54 healthy preterm neonates were assigned to one of the following groups: neonates with birthweight appropriate for gestational age (group 1), neonates small for gestational age without (group 2) and with prenatal haemodynamic disturbances (group 3). We studied Doppler blood flow velocity and resistance index before and after the first feed. Results: Contrary to patients of group 3, infants in groups 1 and 2 showed a significant increase in blood flow velocity and a significant decrease in resistance index from the preprandial values after the first feed. At each postprandial time, we found significant differences in all velocity and resistance measurements between patients of group 3 and patients of both groups 1 and 2. In all patients, we found that the value of mean velocity measured 30 min after the first feed was the most predictive of early feed tolerance, with 95% sensitivity and 94% specificity when mean velocity >0.38 m/s. Conclusion: Small-for-gestational-age preterm infants with prenatal haemodynamic disturbances have an unusual intestinal haemodynamic response to the first feed. In the whole group of preterm infants, the value of mean velocity measured 30 min after the first feed is a good tool for the clinician in predicting early enteral feeding.

Prebiotic concept for infant nutrition

In the neonatal period, the intestine is colonised in a stepwise process that depends on mode of delivery, environmental factors, bacterial interactions, and the host itself resulting in a colonisation with a complex heterogeneous bacterial flora. Oligosaccharides have been identified as an important prebiotic factor of human milk As long as analogues of human milk oligosaccharides are not available now and in the near future it is aimed to resemble the prebiotic effect of human milk by oligosaccharides from available sources. In the present study in preterm infants, a mixture of 90% galacto-oligosaccharides and 10% fructo-oligosaccharides has been tested. The mixture of GOS/FOS was composed to mimic the molecule size distribution of human milk oligosaccharides. Microbiological analysis of the faces was performed before and 7, 14, and 28 days after start of supplementation and stool characteristics have been recorded. Maltodextrin was used as placebo and infants fed human milk have been used as reference. After a 28 days feeding period, the number of bifidobacteria of the group fed the oligosaccharide supplemented formula was in the upper range of the reference group whereas the numbers of the group fed the formula supplemented with the placebo were in the lower range of the reference group (placebo: 7.9 ± 0.83 and GOS/FOS mixture: 10,0 ± 2.05 log 10 CFU/g wet stool; reference (M ± SD): 7.14-10.7 log 10 CFU/g wet stool). Stool characteristics in the group fed the supplemented formula were close to those found in the human milk fed infants. In summary, supplementation of a preterm formula with a mixture of galacto- and fructo-oligosaccharides has a stimulating effect on the growth of bifidobacteria in the intestine and results in more frequent produced and softer stools. Thus, prebiotic mixtures such like the studied oligosaccharide mixture might help in improving intestinal tolerance to enteral feeding in preterm infants.

Supplementation of a bovine milk formula with an oligosaccharide mixture increases counts of faecal bifidobacteria in preterm infants

Background: The establishment of a balanced intestinal microflora which may protect against infection is desirable for the preterm infant. Objective: To investigate the effect of a preterm formula milk supplement...

Prediction of early tolerance to enteral feeding in preterm infants by measurement of superior mesenteric artery blood flow velocity

AIMSTo evaluate whether serial Doppler measurements of superior mesenteric artery (SMA) blood flow velocity after the first enteral feed could predict early tolerance to enteral feeding in preterm infants.METHODSWhen clinicians...

Hydrolysed protein accelerates the gastrointestinal transport of formula in preterm infants

Vomiting, large gastric residuals and abdominal distension are common in very immature infants on formula feeding. The present trial investigated whether a protein hydrolysate formula reduces the gastrointestinal transit time in preterm infants. Fifteen preterm infants (median gestational age 29 (24–32) wk, birthweight 1241 (660–1900) g, postnatal age 18 (5–54) d) on full enteral feeds (&gt;150 ml/kg*d) were enrolled. It was hypothesized that the gastrointestinal transit time is at least 2 h shorter when protein hydrolysate formula is fed compared with standard preterm formula. In a randomized cross‐over design study, each formula was fed for 5 d. On days 4 and 9 the gastrointestinal transit time was estimated using carmine red. The protein hydrolysate formula had a markedly shorter gastrointestinal transit time (9.8 h) than the standard formula (19 h) (p= 0.0022, two‐sided Mann‐Whitney U test). Conclusion: The hydrolysate protein formula accelerated gastrointestinal transit of milk and stools, but whether hydrolysate formulas enable a more rapid establishment of full enteral feeding in preterm infants needs to be investigated.