Slow Feeding Research Articles

Effects of rapid enteral feed advancement with early human milk fortification in very low birth weight preterm infants > 30 weeks gestation in a resource limited setting- a randomized controlled trial.

To study the effects of rapid enteral feed advancement with early feed fortification in stable very low birth weight (VLBW) infants >30 weeks gestation. Preterm infants (N = 92) were randomized to a) rapid feed advancement-early fortification - REF group (enteral feed advanced at 25-30 ml/kg/day, fortification at 50 ml/kg/day) or b) slow feed advancement-late fortification-SLF group (feed advanced at 15-20 ml/kg/day, fortification at 100 ml/kg/day). The primary outcome-time to regain birth weight was significantly lower in REF group (9 days vs 13 days, P = 0.02). REF group reached full enteral feeds earlier (6 days vs 9 days, P = 0.001), had lower rates of sepsis (13% vs 38%, P = 0.007) and shorter hospital stay (10 days vs 15 days, P = 0.01). At one year, the median Z-scores for weight [-1.5 vs -2.2, P < 0.001] and head circumference [1.1 vs 0, P < 0.001) were significantly higher in the REF group. In VLBW preterm infants >30 weeks, rapid feed advancement with early fortification resulted in early postnatal regain of birth weight with positive effects on growth at one year.

A novel chemokine binding protein 1-like gene is vital for the blood pool development and engorgement of the hard tick Haemaphysalis longicornis

Tick saliva modulates host responses during a blood feeding process. We identified a novel chemokine binding protein 1-like (HLCBP1-like) gene from the salivary glands of the Asian longhorned tick, Haemaphysalis longicornis. The HLCBP1-like protein, lacking a well-defined conserved domain, showed structural similarity to evasin, a chemokine binding protein from the brown dog tick, Rhipicephalus sanguineus. A preliminary knockdown study of HLCBP1-like revealed that ticks with reduced expression of this gene, halted feeding in the early feeding phase, and did not fully-engorge, unlike the control dsRNA (malE) injected ticks. Also, knockdown ticks induced cellular immune responses in the host skin, similar to control dsmalE-injected ticks, but did not show hemorrhage. These findings suggest that HLCBP1-like may play a modulatory role in the slow feeding phase.

Clinical Outcomes of Slow versus Rapid Enteral Feeding Advancement in Very Low Birth Weight Neonates at a Tertiary Care Center

In India, every year around 3.5 million babies are born premature, accounting for almost 13% of total livebirths in the country as compared to 5% to 7% incidence in the West. Preterm is defined as babies born before 37 weeks ofpregnancy. The rapidity of feed volume increments involves controversies like faster weight gain, shorter hospital stays, therisk of necrotizing enterocolitis and vice versa. Methods: The present study was a randomized controlled trial conducted fromJune 1, 2018 to October 31, 2019. All infants in the study were randomized to slow and rapid feeding protocols by a stratifiedblock randomization sequence of 2, 4, 6 blocks. Group 1 or the slow advancement group included 64 newborns babies andGroup 2 or the rapid advancement group included 69 newborns babies. Results: The average weight gain in Group 1 was4.41 ± 0.9 g and in Group 2 it was 6.33 ± 1.3 g, the difference was statistically significant (p &lt; 0.02). Sixty out of 64 newbornsregained birth weight within 16.87 ± 0.9 days in Group 1, while 64 out of 69 newborns regained birth weight within 13.63 ±0.9 days in Group 2. The difference was statistically significant. Increment in the mean occipitofrontal circumference perweek was 0.29 ± 0.27 cm Group 1, while in Group 2 it was 0.42 ± 0.05 cm; the difference was statistically significant. Meanaverage length increment per week was found to be 0.55 ± 0.04 cm and 0.69 ± 0.05 cm in Group 1 and Group 2, respectively,the difference was statistically significant (p &lt; 0.005). The mean duration of hospital stay was 27.47 ± 3.33 days in Group 1while in Group 2, the duration of stay was 23.15 ± 2.22 days, the difference was statistically significant. Conclusion: Ourstudy supports enteral nutrition by rapid enteral feeding regimen in stable preterm neonates with very low birth weight

Feeding behaviour related to different feeding devices.

Slow feeding devices (SFDs) are useful tools in order to improve the horse well-being and to reduce wastage, but their use may result in unnatural posture during feeding and frustration behaviours. Moreover, it may be important to evaluate the laterality during feeding. The aim of the study was to investigate ponies' feeding behaviour (i.e., lateralisation, frustration, postural eating style) with different hay feeding methods: on the ground (G), a fully filled hay net (HF), a partially filled hay net (HL), and a slow feeder hay box (HB). Nine ponies of two different breed types (Shetland and Welsh/Cob) were evaluated. Video recordings were obtained and then behavioural analysis was conducted. Data were analysed statistically using k-means cluster analysis, repeated measurement mixed model procedure, principal component analysis (PCA) and Pearson's correlation coefficient. Head tilting was more often performed during feeding from HF and HL compared to G and HB. Forelimb forward, referring to the position that ponies assumed during feeding, was performed less frequently with the hay nets. Ponies, in particular Welsh/Cobs, tended to be more left-lateralized and performed more backward ears when feeding from the hay nets. Blink rate was observed to be greater when ponies were fed from G. No head pushing, striking with forelimb and pawing while feeding was seen. Animals fed from HF tended to eat from the top of the hay net and consequently showed an arched neck; while HL and HB showed for elongated neck an intermediate pattern between G and HF. From our results, HB seemed to be a useful compromise between natural feeding on the ground and the use of hay nets.

PSIV-A-8 Effects of meal frequency on heart rate in horses

Abstract In humans, meal size has been shown to affect heart function with meal ingestion being associated with an increase in heart rate (HR) and cardiac output lasting significantly longer when larger meals are consumed. In horses, HR spikes at the sight of feed due to anticipation, but no studies have specifically evaluated the effect of meal frequency or size on HR. Heart rate has also been used as a measure both positive and negative stress. Domesticated horses are often meal fed, with small frequent meals requiring more labor than large infrequent meals. Fewer larger meals may have negative welfare implications for a grazing species. As part of a larger project investigating the effects of meal frequency on the behavior and metabolism of horses, the objective of this study was to evaluate equine HR in response to feeding frequencies commonly practiced in the field [once (1x), twice (2x), or thrice (3x) per day]. Feeding times were at 0800 (1x, 2x, and 3x), 1300 (3x), and 1800 (2x and 3x) h. The 12 adult clinically healthy horses [average ± SD; 14 ± 6 yr and 572 ± 32 kg body weight (BW)] were separated into two equal groups before completing a 14-d acclimation period to the diet during which they were fed 2x. The diet was provided at 2% BW on a dry matter (DM) basis (1.55% BW grass hay in a slow feed hay net plus 0.45% BW complementary fortified feed). During the study the same diet was fed but the meal frequency, and therefore meal size, differed between the treatments. The order of treatments, lasting 1 wk each, was decided at random for each group. On d 6 of each treatment HR was measured using individual H10 Polar HR monitors, which recorded every second from 0700 to 1900 h yielding 1,514,799 data points. During this time the aisleways housing the stalled horses were blocked off to minimize exposure to human presence other than at feeding time(s). After removing outliers, the mode was calculated for HR of each horse, which was considered to be the resting HR for that horse and ranged from 31 to 46 beats/min. The percentage of data above, below, or at the mode was calculated for each horse over the 12 h period and evaluated using Chi Square tests for statistical significance. The proportion of HR values above, below, or at the mode differed between treatments (P = 0.02). When fed 1x, 69 ± 14% of the HR readings were above the mode on average, as compared with 42 ± 18% and 44 ± 18% for 2x and 3x, respectively. These results suggest that the increase in HR was more than anticipatory and that there may be sustained stress when horses are fed at fewer frequency, such as once daily.

Clinical Outcomes of Slow versus Rapid Enteral Feeding Advancement in Very Low Birth Weight Neonates at a Tertiary Care Center

In India, every year around 3.5 million babies are born premature, accounting for almost 13% of total livebirths in the country as compared to 5% to 7% incidence in the West. Preterm is defined as babies born before 37 weeks ofpregnancy. The rapidity of feed volume increments involves controversies like faster weight gain, shorter hospital stays, therisk of necrotizing enterocolitis and vice versa. Methods: The present study was a randomized controlled trial conducted fromJune 1, 2018 to October 31, 2019. All infants in the study were randomized to slow and rapid feeding protocols by a stratifiedblock randomization sequence of 2, 4, 6 blocks. Group 1 or the slow advancement group included 64 newborns babies andGroup 2 or the rapid advancement group included 69 newborns babies. Results: The average weight gain in Group 1 was4.41 ± 0.9 g and in Group 2 it was 6.33 ± 1.3 g, the difference was statistically significant (p &lt; 0.02). Sixty out of 64 newbornsregained birth weight within 16.87 ± 0.9 days in Group 1, while 64 out of 69 newborns regained birth weight within 13.63 ±0.9 days in Group 2. The difference was statistically significant. Increment in the mean occipitofrontal circumference perweek was 0.29 ± 0.27 cm Group 1, while in Group 2 it was 0.42 ± 0.05 cm; the difference was statistically significant. Meanaverage length increment per week was found to be 0.55 ± 0.04 cm and 0.69 ± 0.05 cm in Group 1 and Group 2, respectively,the difference was statistically significant (p &lt; 0.005). The mean duration of hospital stay was 27.47 ± 3.33 days in Group 1while in Group 2, the duration of stay was 23.15 ± 2.22 days, the difference was statistically significant. Conclusion: Ourstudy supports enteral nutrition by rapid enteral feeding regimen in stable preterm neonates with very low birth weight

Changes in saliva protein profile throughout Rhipicephalus microplus blood feeding

BackgroundWhen feeding on a vertebrate host, ticks secrete saliva, which is a complex mixture of proteins, lipids, and other molecules. Tick saliva assists the vector in modulating host hemostasis, immunity, and tissue repair mechanisms. While helping the vector to feed, its saliva modifies the site where pathogens are inoculated and often facilitates the infection process. The objective of this study is to uncover the variation in protein composition of Rhipicephalus microplus saliva during blood feeding.MethodsTicks were fed on calves, and adult females were collected, weighed, and divided in nine weight groups, representing the slow and rapid feeding phases of blood feeding. Tick saliva was collected, and mass spectrometry analyses were used to identify differentially secreted proteins. Bioinformatic tools were employed to predict the structural and functional features of the salivary proteins. Reciprocal best hit analyses were used to identify conserved families of salivary proteins secreted by other tick species.ResultsChanges in the protein secretion profiles of R. microplus adult female saliva during the blood feeding were observed, characterizing the phenomenon known as “sialome switching.” This observation validates the idea that the switch in protein expression may serve as a mechanism for evading host responses against tick feeding. Cattle tick saliva is predominantly rich in heme-binding proteins, secreted conserved proteins, lipocalins, and protease inhibitors, many of which are conserved and present in the saliva of other tick species. Additionally, another remarkable observation was the identification of host-derived proteins as a component of tick saliva.ConclusionsOverall, this study brings new insights to understanding the dynamics of the proteomic profile of tick saliva, which is an important component of tick feeding biology. The results presented here, along with the disclosed sequences, contribute to our understanding of tick feeding biology and might aid in the identification of new targets for the development of novel anti-tick methods.Graphical

Energy Dense Feeding in Premature Infants and Its’ Associated Outcomes

COVID-19 infection in pregnant mothers is associated with higher risk of intrauterine growth retardation and premature births. Very low birth weight infants are more susceptible to neurodevelopmental and chronic respiratory problems. An infant delivered at 33 weeks via caesarean section to a COVID-19 Stage 5A positive mother, weighing 1.43kg at birth. She was kept nil by mouth with parenteral nutrition (PN) support since day five of life until referred to dietitian on day 22 of life for enteral nutrition (EN) establishment. Feeding was administered intermittently via oro-gastric Ryle’s Tube. She was kept under non-invasive ventilation (NIV) mode and had difficulty in weaning from ventilation, leading to slow feeding progress. Initially, enteral trophic feeding was administered using premature infant formula fortified with modular products. In the later stage of feeding, modular products were tapered off and the formula was concentrated. Frequency of bowel output when using fortified formula is lesser compared to when using concentrated and supplemented formula. There is no significant difference in renal profile observed in both stages of feeding. Increasing energy intake using easily digestible sources is preferable as opposed to concentrating feeds even further due to concerns about osmolality and excess administration of other solutes. Intermittent bolus feeding mode may have an effect on dependency on oxygen since intermittent feeds can decrease tidal volume, minute ventilation and dynamic compliance. Additional research is necessary to establish optimal caloric density and nutritional compositions of feedings, feeding mechanisms and its’ effect on feeding tolerance.

Effect of different feeding strategies on performance of aerobic granular sludge: From perspective of extracellular polymeric substances and microorganisms

Long-term structural stability of aerobic granular sludge (AGS) is a major challenge in AGS biotechnology. This work investigated variations in the sludge performance, structural stability, and intrinsic mechanisms of AGS under three feeding strategies (R1 direct aeration after fast feeding, R2 anaerobic stirring after fast feeding and R3 anaerobic plug-flow slow feeding). The AGS sequencing batch reactor used in this study was in stable operation with biomass of 6–10 gMLSS/L and a hydraulic retention time of 4 h. The results showed that the best sludge performance was demonstrated in R3, followed by R2 and R1. These differences were caused by extracellular polymeric substances (EPS) and microbial communities. The excellent sludge performance in R3 was attributed to the high hydrophobicity in the EPS as well as the gel properties due to the high hydrogen bonding content in the exopolysaccharide (PS). Similarly, the gel properties formed by the high hydrogen bonding content maintain the sludge stability in R1. Slow-growing dominant bacteria were enriched in the AGS of R2 and R3 with alternating anaerobic/aerobic operation modes, resulting in outstanding sludge performance. In contrast, high abundance of the filamentous bacteria Neomegalonema was enriched in the AGS of R1 without an anaerobic phase, resulting in relatively poor sludge stability. Variations in EPS characteristics and microbial community under the different feeding strategies were the main mechanisms responsible for the long-term operation of AGS. This study could provide a theoretical foundation and technical assistance for the sustainable operation of AGS reactors.

Slow verses rapid advancement of enteral feed in preterm neonates of 28-34 weeks of gestational age with abnormal antenatal umbilical artery Doppler: A randomised controlled trial

Background: Necrotising enterocolitis (NEC) is the commonest and most serious gastrointestinal neonatal emergency. In preterm infants with evidence of abnormal Doppler flow velocities in the fetal umbilical artery, suboptimal intestinal perfusion is postulated to increase the risk of feed intolerance and NEC.Objectives: To compare the effect of slow versus rapid enteral feeding in preterm neonates with abnormal antenatal umbilical artery Doppler.Method: This is a randomised controlled trial; we randomised into a slow and a fast group; we randomised separately into subcategories based on the weight. Sample size was calculated as 82. Data analysis was done using SPSS version 23. For group comparisons of categorical data, Chi-squared test was used. If expected frequency in the contingency tables was &lt;5 for more than 25% cells, Fisher’s exact test was used. For non-parametric continuous data Mann-Whitney test was applied. Statistical significance was kept at p&lt;0.05 and power at 80%.Results: In neonates with slow and rapid feeding with birth weight &lt;1250g, percentage of 2b (30% and 26.7% respectively) was more compared to other stages, whereas in group with birth weight ≥1250g rapid feeding group Ia (14.3%) was more in slow feeding group and 1a and 2a equal in rapid feeding group with no statistical significance. The mean duration of stay hospital was less in rapid feeding group in both birth strata. The sepsis percentage was more in the slow feeding group. Regarding mortality in both groups, there was no statistical difference.Conclusions: In this study the type of feeding did not affect NEC or feeding intolerance in preterm infants. Rapid feeding had a significant impact on sepsis and length of stay in preterm infants.

Neonatal hypertrophic cardiomyopathy with dyspnoea as the first symptom: a case report

Neonatal hypertrophic cardiomyopathy (HCM) is an idiopathic disease characterised by myocardial hypertrophy with normal or small ventricular chambers, a systolic hyperdynamic state and diastolic dysfunction. The etiology, pathogenesis and clinical manifestations of HCM are diverse, and it is likely to progress to sudden cardiac death. The highly heterogeneous nature of this disease determines the difficulty of its diagnosis, and it is especially rare to report that can be diagnosed conclusively in the neonatal period. However, when it does occur, the younger the age of onset is, the higher the mortality rate and the worse the prognosis. The genetic variants and diagnostic timing can affect the life course of the patient. This case report describes a neonate with a family history of HCM who was diagnosed with hypertrophic non-obstructive cardiomyopathy by echocardiography shortly after birth. At 4 years of age, the patient presented with slow weight gain, feeding difficulties, tachypnoea and diaphoresis, and cardiac ultrasound findings suggesting progression to severe hypertrophic obstructive cardiomyopathy, with a high likelihood of arrhythmias, heart failure, pulmonary hypertension, syncope and even sudden death. Neonatal congenital hypertrophic cardiomyopathy is extremely rare and difficult to diagnose before the onset of symptoms. Echocardiography has a definite diagnostic value in hypertrophic cardiomyopathy and helps in early detection and treatment. At the time of clinical diagnosis, children with hypertrophic cardiomyopathy should be asked about their family history and, if necessary, a survey of family members should be conducted for the early detection of mildly ill patients and gene carriers to enable timely intervention and treatment, which remains the focus of our research and efforts.

Dietary Behavior of Spanish Schoolchildren in Relation to the Polygenic Risk of Obesity

Several precedents support an association between single nucleotide genetic polymorphisms (SNPs), the obese phenotype, and eating behavior in the infant-juvenile population. This study aims to study this aspect in depth, analyzing the eating behavior of a sample of schoolchildren from Madrid in regard to their genetic predisposition to obesity. A total of 258 schoolchildren, aged 6 to 16 years, were evaluated through the Children’s Eating Behaviour Questionnaire (CEBQ) and the genotyping of 32 SNPs. Associations were observed between the total genetic risk score and eating behaviors related to emotional eating and food responsiveness. Individually, different SNPs were associated with eating behaviors, primarily those related to pro-eating behaviors or increased risk of developing obesity. However, diverse results are obtained, depending on the SNP. These results highlighted the strongest associations between the rs1801725 SNP risk allele (CASR) and increased enjoyment of food by 1846-fold. Likewise, the satiety response was associated with SNP rs11676272 (ADCY3) 2.39 and SNP rs7566605 (INSIG2), increasing this response by 2.39 and 1.63 times, respectively. Emotional anti-ingesting behaviors were inversely associated with SNP rs1421085 (FTO) and SNP rs987237 (TFAP2B). In contrast, SNP rs55915917 (CRHR1) increased the risk of these behaviors. SNPs rs4788099 (SH2B1), rs6857 (NECTIN2), and rs180172 (ADCY3) were associated with slow feeding. In conclusion, associations were found between most of the analyzed SNPs and the CEBQ items. This suggests that feeding behavior exists as a mediator between genotype and obesity phenotype, beginning in childhood.

A Comparison of Slow Infusion Intermittent Feeding versus Gravity Feeding in Preterm Infants: A Randomized Controlled Trial.

The transition to full enteral feeding is important for ensuring adequate growth in preterm infants. The aim of this study was to investigate the effects of two different intermittent feeding methods on the transition to full enteral feeding in preterm infants. A prospective, randomized controlled study was conducted in a neonatology and perinatology center. Preterm infants with a gestational age between 24 + 0/7 and 31 + 6/7 were included in this study. They were divided into two groups: the SIF (slow infusion feeding) group and the IBF (intermittent bolus feeding) group. In the SIF group, feed volumes were administered over one hour using an infusion pump through an orogastric tube, with feeding occurring every three hours. The IBF group received enteral feeding using a gravity-based technique with a syringe through an orogastric tube, completed within 10 to 30 min. The primary outcome was the achievement of full enteral feeding and the occurrence of feeding intolerance. A total of 103 infants were enrolled in the study (50 in SIF and 53 in IBF). The time to achieve full enteral feeding did not differ significantly between the two groups (p = 0.20). The SIF group had significantly fewer occurrences in which gastric residual volume exceeded 50% (p = 0.01). Moreover, the SIF group had a significantly shorter duration of non-per-oral (NPO) status than the IBF group (p = 0.03). It is our contention that the use of the SIF method as an alternative feeding method is appropriate for infants with feeding intolerance and those at high risk of feeding intolerance.

A longitudinal transcriptomic analysis from unfed to post-engorgement midguts of adult female Ixodes scapularis

The hematophagy behavior has evolved independently several times within the Arthropoda phylum. Interestingly, the process of acquiring a blood meal in ticks is considerably distinct from that observed in other blood-feeding arthropods. Instead of taking seconds to minutes to complete a blood meal, an adult female Ixodes scapularis tick can remain attached to its host for numerous days. During this extended feeding period, the tick undergoes drastic morphological changes. It is well established that the tick midgut plays a pivotal role not only in blood meal digestion but also in pathogen acquisition and transmission. However, our understanding of the underlying molecular mechanisms involved in these events remains limited. To expedite tick research, we conducted a comprehensive longitudinal RNA-sequencing of the tick midgut before, during, and after feeding. By collecting ticks in different feeding stages (unfed, slow feeding, rapid feeding, and early post-detached), we obtained a comprehensive overview of the transcripts present in each stage and the dynamic transcriptional changes that occur between them. This provides valuable insights into tick physiology. Additionally, through unsupervised clustering, we identified transcripts with similar patterns and stage-specific sequences. These findings serve as a foundation for selecting targets in the development of anti-tick control strategies and facilitate a better understanding of how blood feeding and pathogen infection impact tick physiology.

Very low birthweight infants receive less enteral feeding than what is prescribed.

Feeding a very low birthweight (VLBW, <1500 g) infant is challenging. Our aims were to study how prescribed enteral feeding is implemented in VLBW infants and to identify factors associating with slow enteral feeding progression. Our retrospective cohort included 516 VLBW infants born before 32 weeks of gestation during 2005-2013 and admitted to Children's Hospital, Helsinki, Finland, for at least the two first weeks of life. Nutritional data were collected from birth until the age of 14-28 days, depending on the length of stay. We found that enteral feeding progressed slower than recommended and implementation differed from the prescriptions, especially during the parenteral nutrition phase (milk intake 10-20 mL/kg/day): 71% [40-100], median [IQR], of the prescribed enteral milk was administered. The full prescribed amount was less likely administered if a higher volume of gastric residual was aspirated or if the infant did not pass stool during the same day. Longer opiate use, patent ductus arteriosus, respiratory distress syndrome and slower passage of the first meconium associated with slower enteral feeding progression. Enteral feeding of a VLBW infant is often not administered as prescribed, which possibly plays a significant role in the slow progression of enteral feeding.

Bovine colostrum to supplement the first feeding of very preterm infants: The PreColos randomized controlled trial

Gut immaturity leads to feeding difficulties in very preterm infants (<32 weeks gestation at birth). Maternal milk (MM) is the optimal diet but often absent or insufficient. We hypothesized that bovine colostrum (BC), rich in protein and bioactive components, improves enteral feeding progression, relative to preterm formula (PF), when supplemented to MM. Aim of the study is to determine whether BC supplementation to MM during the first 14 days of life shortens the time to full enteral feeding (120mL/kg/d, TFF120). This was a multicenter, randomized, controlled trial at seven hospitals in South China without access to human donor milk and with slow feeding progression. Infants were randomly assigned to receive BC or PF when MM was insufficient. Volume of BC was restricted by recommended protein intake (4-4.5g/kg/d). Primary outcome was TFF120. Feeding intolerance, growth, morbidities and blood parameters were recorded to assess safety. A total of 350 infants were recruited. BC supplementation had no effect on TFF120 in intention-to-treat analysis [n (BC)=171, n (PF)=179; adjusted hazard ratio, aHR: 0.82 (95% CI: 0.64, 1.06); P=0.13]. Body growth and morbidities did not differ, but more cases of periventricular leukomalacia were detected in the infants fed BC (5/155 vs. 0/181, P=0.06). Blood chemistry and hematology data were similar between the intervention groups. BC supplementation during the first two weeks of life did not reduce TFF120 and had only marginal effects on clinical variables. Clinical effects of BC supplementation on very preterm infants in the first weeks of life may depend on feeding regimen and remaining milk diet. http://www. gov: NCT03085277.

The Impact of Slow Infusion Intermittent Feeding on Gavage Feeding-Associated Cardiorespiratory Deterioration in Neonatal Intensive Care Unit Infants

Purpose: Infants in the neonatal intensive care unit (NICU) often show cardiorespiratory deterioration during gavage feeding. We aimed to determine whether slow infusion intermittent feeding (SIIF) can reduce respiratory deterioration during gavage feeding in preterm infants in the NICU.Methods: Data on preterm infants whose gavage feeding method was changed to SIIF (1-­­hour infusion with an infusion pump and 2-­hour rest within a 3­-hour interval) from bolus gravity feeding (2-­ or 3-­hour interval) due to feeding­-associated cardiorespiratory deterioration were retrospectively reviewed. A significant cardiorespiratory event was defined as a saturation level below 80% or heart rate below 80 bpm. We compared the frequency of cardiorespiratory events and the level of respiratory support 24 hours before and after the application of SIIF.Results: A total of 34 infants were enrolled and analyzed. The total frequency of desaturation or bradycardia significantly decreased after SIIF application (8.94 vs. 5.03, &lt;i&gt;P&lt;/i&gt;=0.001). The frequency of feeding-­related bradycardia and desaturation also significantly decreased (4.15 vs. 1.68, &lt;i&gt;P&lt;/i&gt;=0.008). Out of 34 patients, 11 (32.4%) had a decreased level of ventilator support within 1 day after SIIF. The respiratory severity scores of the 10 patients who received invasive ventilator support decreased significantly after SIIF (5.24 vs. 4.59, &lt;i&gt;P&lt;/i&gt;=0.032).Conclusion: SIIF significantly decreased gavage feeding­-associated cardiorespiratory events and reduced respiratory support in approximately one-­third of subjects. Therefore, SIIF may be a therapeutic option for gavage feed-­associated respiratory deterioration in preterm infants in the NICU.

60 Bite and mouth shape variations assessment during different slow-feeding management in ponies: A geometric morphometric evaluation

Previous studies have highlighted the influence of different slow-feeding devices on behavior, intake rate and body postures of stabled equines. There is still, however, a lack of knowledge on how feeding devices change the biting mechanism and ultimately chewing behavior. The aim of our study was to evaluate the variation of bite and mouth shape in ponies fed the same forage by different feeding methods. Nine ponies belonging to 2 breed types - Shetland (n = 5, SH) and Welsh Cob (n = 4, WC) types - were used (mean ± SD: 12 ± 4 years and a BCS:7.6 ± 0.7/9). Breed type designation was assigned according to owner information and body morphometric measurements. A first cut meadow hay was offered to SH and WC ponies in 4 ways following a Latin square design: 3 kg of hay fed on the ground (G); or a small-holed hay net (3.5 × 3.5 cm holes) filled with 3 kg (Haynet full fill, HNF) or 1 kg (Haynet light fill, HNL) of hay; or a newly developed slow feeder (Haybox, HB) containing 3 kg of hay. The 2 hay nets were optimally placed, according to previous work, with the hay net base at the same height as the pony's elbow. Each pony was video recorded 3 times per feeding method and from the video at least 10 still frames/pony/feeding method were selected. A specific point configuration comprising 9 landmarks was developed and geometric morphometrics was applied to study variation in bite and mouthshape. Data were statistically analyzed using principal component analysis (PCA) and canonical variate analysis (CVA). When ponies were fed on the ground (G), the CVA showed the lowest variation (35.7%) in the bite and mouth shape, suggesting a similar biting mechanism despite the morphometric differences between the 2 breed types. In contrast, the use of the slow feeding devices – HB, HNF, HNL – showed higher values of shape variation between the breeds. Interestingly, the highest variation was reported when using the HNL (83.2%), followed by the HB (78.3%) and by the HNF (76.7%), highlighting that each feeding device made the animal alter their biting mechanism. These results were confirmed visually through PCA analysis, demonstrating that the features of the feeding device influenced the mouth shape. Our study suggested that the use of slow-feeding devices, of different size and capacity, not only can alter the intake rate of ponies but can also affect their way of feeding in terms of bite and mouth shape regardless of their morphology. This should be taken into account in further studies on slow feeding management, with the aim to fully understand the effects of different devices on feed intake mechanics.

Non-filamentous sludge bulking induced by exopolysaccharide variation in structure and properties during aerobic granulation

The forming mechanism of non-filamentous sludge bulking during aerobic granulation were investigated basing on three feeding strategies (R1 direct aeration after fast feeding, R2 anaerobic stirring after fast feeding and R3 anaerobic plug-flow slow feeding). Results showed that strong selection stress (shortening settling time) led to a sharp flocs washout and the subsequent increase of food to microorganisms (F/M) in R1 and R3 reactors, but not found in R2 due to the different strategies of feeding modes. With the increase of F/M, zeta potential and hydrophobicity of sludge surfaces significantly decreased and thus leading to an enhanced repulsive force and energy barriers for sludge aggregation. Particularly, when F/M exceeded 1.2 kgCOD/(kgMLSS·d), non-filamentous sludge bulking was ultimately triggered in R1 and R3. Further analysis showed that massive extracellular exopolysaccharide (PS) accumulated on the surfaces of non-filamentous bulking sludge due to the increased abundance of the microorganisms related to PS secretion during sludge bulking. In addition, significantly increased intracellular second messenger (c-di-GMP), a key substance regulating PS biosynthesis, was confirmed via its concentration determination as well as microbial function prediction analysis, which played a critical role in sludge bulking. Combing with the systematic detection from surface plasmon resonance system, rheometer and size-exclusion chromatography-multiangle laser light detection-refractive index system, higher molecular weight, compact conformation, higher viscosity and higher hydrophilicity was determined in sludge bulking PS relative to PS extracted from non-filamentous bulking sludge. Clearly, the changes of PS (content, structures and properties) driven by c-di-GMP are the dominant mechanism for the formation of non-filamentous sludge bulking during aerobic granulation. This work could provide theoretical support for successful start-up and application of aerobic granular sludge technology.

Early-Life Slow Enteral Feeding Progression Pattern Is Associated with Longitudinal Head-Size Growth Faltering and Neurodevelopmental Impairment Outcomes in Extremely Preterm Infants

To determine whether feeding progression patterns in the first eight postnatal weeks, depicted by clustering analysis of daily enteral feeding volume, are associated with longitudinal head-circumference (HC) growth and neurodevelopmental outcomes in extremely preterm (EP) infants. 200 infants who were admitted at gestational ages 23-27 weeks between 2011 and 2018; survived to discharge; and underwent longitudinal HC growth measurements at birth, term-equivalent age (TEA), corrected age (CA) 6-month, 12-month, and 24-month; and neurodevelopmental assessment using the Bayley Scales of Infant Development at CA 24 months were included for analysis. kmlShape analysis identified two distinct enteral feeding progression patterns: fast progression in 131 (66%) infants and slow progression in 69 (34%) infants. Compared to the fast progression group, the slow progression group showed significantly lower daily enteral volumes after day 13, was older in postnatal age reaching full feeding, had a higher rate of Delta z scores of HC (zHC) < -1 (p < 0.001) between birth and TEA, and displayed lower longitudinal zHC from TEA to CA 24 months. The slow progression group also showed higher rates of microcephaly [42% vs. 16%, p < 0.001; adjusted odd ratio (aOR): 3.269, p = 0.001] and neurodevelopmental impairment (NDI) (38% vs. 19%, p = 0.007; aOR: 2.095, p = 0.035) at CA 24 months. For NDI, the model including feeding progression patterns showed a lower Akaike information criterion score and a better goodness of fit than the model that did not include feeding patterns. Characterizing feeding progression pattern may help identify EP infants at high-risk of head-size growth faltering and NDI at early childhood.