Advancement of enteral feeding in preterm infants, assessment of gastric residuals

Česká verze

Authors: L. Nedvědová; J. Dušek
Authors place of work: Neonatologické oddělení Nemocnice České Budějovice, a. s.
Published in the journal: Čes-slov Neonat 2025; 31 (2): 73-78.
Category: Původní práce

Summary

Nutritional management is an important part of neonatal care and it is crucial for optimal growth and health in the early postnatal period, especially in premature newborns. Newborns with very low and extremely low birth weight initially require parenteral nutritional support, but enteral nutrition (optimally in the form of colostrum) is preferred. Intravenous nutrition carries the risk of infectious or metabolic complications, including intestinal mucosal atrophy. The desired goal is therefore the shortest possible period of parenteral nutrition and full enteral intake to ensure adequate growth. According to available data, a progressive increase in enteral nutrition doses, as opposed to a slow increase, does not lead to an increased incidence of necrotizing enterocolitis, and children benefit from a faster transition to a full enteral diet. Currently, it is recommended to start feeding with breast milk even in severely premature newborns soon after birth and to increase the diet according to nutritional tolerance. Assessing nutritional intolerance based solely on the volume of gastric residues is no longer recommended in clinical practice, because it leads to an unjustified delay in full enteral intake. Nutritional intolerance should be assessed comprehensively based on the overall clinical condition. Bolus or continuous feeding via a gastric tube are two fully-fledged alternatives with different advantages that can be used individually in the management of nutritional care.

Keywords:

enteral nutrition – premature newborn – necrotizing enterocolitis – gastric residual volume – rate of advance of enteral feeding – feed intolerance

Zdroje

1. Dorling J, Hewer O, Hurd M, et al. Two speeds of increasing milk feeds for very preterm or very low-birthweight infants: The SIFT RCT. Southampton (UK): NIHR Journals Library 2020. (Health Technology Assessment, No. 24.18.) Dostupné z: https://www. ncbi.nlm.nih.gov/books/NBK556324/. doi: 10.3310/hta24180.

2. Garg S, Sunil S. The rapidity of advancement of feedings inpremature infants: Evidence basis and current recommendations. NeoReviews 2018; 19(11): e675–e681.

3. Radbone L, et al. East of England Neonatal Network Enteral Feeding of preterm infants on the neonatal unit. 2024.

4. Karagol BS, Zenciroglu A, Okumus N, Polin RA. Randomized controlled trial of slow vs rapid enteral feeding advancements on the clinical outcomes of preterm infants with birth weight 750–1250 g. JPEN J Parenter Enteral Nutr 2018; 37 : 223–228. Dostupné z https://doi.org/10.1177/0148607112449482.

5. Thoene M, Anderson-Berry A. Early enteral feeding in preterm infants: A narrative review of the nutritional, metabolic, and developmental benefits. Nutrients 2021; 13(7): 2289. doi: 10.3390/nu13072289. PMID: 34371799; PMCID: PMC8308411.

6. Klevebro S, Westin V, Stoltz Sjöström E, Norman M, Domellöf M, Edstedt Bonamy AK, Hallberg B. Early energy and protein intakes and associations with growth, BPD, and ROP in extremely preterm infants. Clin Nutr 2019; 38(3): 1289–1295. doi: 10.1016/j.clnu.2018.05.012. Epub 2018 May 29. PMID:29885776.

7. Hill PD, Aldag JC, Chatterton RT. Initiation and frequency of pumping and milk production in mothers of non-nursing preterm infants. J Hum Lact 2001; 17(1): 9–13. doi:10.1177/089033440101700103. PMID: 11847858.

8. Notarbartolo V, Giuffrè M, Montante C, Corsello G, Carta M. Composition of human breast milk microbiota and its role in children‘s health. Pediatr Gastroenterol Hepatol Nutr 2022;25(3): 194–210. doi: 10.5223/pghn.2022.25.3.194. Epub 2022 May 9. PMID: 35611376; PMCID: PMC9110848.

9. Peila C, Moro GE, Bertino E, Cavallarin L, Giribaldi M, Giuliani F, Cresi F, Coscia A. The effect of holder pasteurization onnutrients and biologically-active components in donor human milk: A review. Nutrients 2016; 8 : 477. Dostupné z: https://doi.org/10.3390/nu8080477.

10. de Segura AG, Escuder D, Montilla A, Bustos G, Pallás C,Fernández L, Corzo N. and Rodríguez JM. Heating-induced bacteriological and biochemical modifications in human donor milk after holder pasteurisation. J Pediatr Gastroenterol Nutr 2012; 54 : 197–203. Dostupné z: https://doi.org/10.1097/MPG.0b013e318235d50d.

11. Buchman AL, Moukarzel AA, Bhuta S, Belle M, Ament ME, Eckhert CD, Hollander D, Gornbein J, Kopple JD, Vijayaroghavan SR. Parenteral nutrition is associated with intestinal morphologic and functional changes in humans.JPEN J Parenter Enteral Nutr 1995; 19(6): 453–460. doi:10.1177/0148607195019006453. PMID: 8748359.

12. Bronsky J, Campoy C, Braegger C. ESPGHAN/ESPEN/ESPR/CSPEN working group on pediatric parenteral nutrition. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Vitamins. Clin Nutr 2018; 37 : 2366–2378. doi: 10.1016/j.clnu.2018.06.951. [DOI -⁠ PubMed].

13. Pohlandt F, Abrams S, Cooke R. Calcium, magnesium, phosphorus, and vitamin D. In: Tsang RC, Uauy R, Koletzko B, Zlotkin SH, editors. Nutrition of the preterm infant: Scientific basis and practical guidelines. 2nd ed. Digital Educational Publishing, Inc.:Cincinnati (OH, USA) 2005, p. 245.

14. Mills RJ, Davies MW. Enteral Iron Supplementation in Preterm and Low Birth Weight Infants. Cochrane Database Syst Rev 2012; 3: CD005095. doi: 0.1002/14651858.CD005095.pub2.[DOI -⁠ PMC -⁠ PubMed].

15. Loskutova E, Nolan J, Howard A, Beatty S. Macular pigment and its contribution to vision. Nutrients 2013; 5 : 1962–1969. doi: 10.3390/nu5061962. [DOI -⁠ PMC -⁠ PubMed].

16. Coviello C, Keunen K, Kersbergen KJ, Groenendaal F, Leemans A, Peels B, Isgum I, Viergever MA, de Vries LS, Buonocore G, et al. Effects of early nutrition and growth on brain volumes, white matter microstructure, and neurodevelopmental outcome in preterm newborns. Pediatr Res 2018; 83 : 102–110. doi: 10.1038/pr.2017.227. [DOI -⁠ PubMed].

17. Camallan J, Avsar P, Patton D, Moore Z, O‘Connor T, Nugent L, Budri A. What is the effect of fast feed advancement in the duration to establish full enteral feeds among preterm infants ≤35 weeks gestation with birth weight ≤2000 g? A systematic review. J Neonatal Nurs 2023; 29(2): 253–259 doi: 10.1016/j.jnn.2022.07.021.

18. Konnikova Y, Zaman MM, Makda M, D’Onofrio D, Freedman SD, Martin CR. Late enteral feedings are associated with intestinal inflammation and adverse neonatal outcomes. PLoS ONE 2015; 10: e0132924. doi: 10.1371/journal.pone.0132924.[DOI -⁠ PMC -⁠ PubMed].

19. Wemhoner A, Ortner D, Tschirch E, Strasak A, Rudiger M. Nutrition of preterm infants in relation to bronchopulmonary dysplasia. BMC Pulm Med 2011; 11 : 7. doi: 10.1186/1471-2466-11-7. [DOI -⁠ PMC -⁠ PubMed].

20. Berseth CL. Effect of early feeding on maturation of the preterm infant’s small intestine. J Pediatr 1992; 120 : 947–953. doi:10.1016/S0022-3476(05)81969-9. [DOI -⁠ PubMed].

21. Shanahan KH, Yu X, Miller LG, Freedman SD, Martin CR. Early serum gut hormone concentrations associated with time to full enteral feedings in preterm infants. J Pediatr Gastroenterol Nutr 2018; 67 : 97–102. doi: 10.1097/MPG.0000000000001987.[DOI -⁠ PubMed].

22. Wildhaber BE, Yang H, Spencer AU, Drongowski RA, Teitelbaum DH. Lack of enteral nutrition—Effects on the intestinal immune system. J Surg Res 2005; 123 : 8–16. doi: 10.1016/j.jss.2004.06.015. [DOI -⁠ PubMed].

23. Anderson DM, and Kliegman RM. The relationship of neonatal alimentation practices to the occurrence of endemic necrotising enterocolitis. Am J Perinatol 1991; 8 : 62–67.

24. Rayyis SF, et al. Randomised trial of “slow” versus “fast” feed advancements on the incidence of necrotising enterocolitis in very low birth weight infants. J Pediatr 1999; 134 : 293–297.

25. Embleton ND, Moltu SJ, Lapillonne A, van den Akker CHP, Carnielli V, Fusch C, Gerasimidis K, van Goudoever JB, Haiden N, Iacobelli S, Johnson MJ, Meyer S, Mihatsch W, de Pipaon MS, Rigo J, Zachariassen G, Bronsky J, Indrio F, Köglmeier J, de Koning B, Norsa L, Verduci E, Domellöf M. Enteral nutrition in preterm infants: A position paper from the ESPGHAN Committee on Nutrition and Invited Experts. J Pediatr Gastroenterol Nutr 2023; 76(2): 248–268. doi: 10.1097/MPG.0000000000003642. Epub 2022 Oct 28. PMID: 36705703.

26. Latheef F, Wahlgren H, Lilja HE, Diderholm B, Paulsson M. The risk of necrotizing enterocolitis following the administration of hyperosmolar enteral medications to extremely preterm infants. Neonatology 2021; 118(1): 73–79. doi:10.1159/000513169. Epub 2021 Feb 10. PMID: 33567438.

27. Oddie SJ, Young L, McGuire W. Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants. Cochrane Database Syst Rev 2021; 8:CD001241. DOI: 10.1002/14651858.CD001241.pub8.

28. Salas AA, Kabani N, Travers CP, et al. Short versus extended duration of trophic feeding to reduce time to achieve full enteral feeding in extremely preterm infants: An observational study. Neonatology 2017; 112(3): 211–216.

29. McClure RJ. Trophic feeding of the preterm infant. Acta Paediatr Suppl 2001; 90(436): 19–21.

30. Neu J. Gastrointestinal development and meeting the nutritional needs of premature infants. Am J Clin Nutr 2007; 85(2): 629S–634S. doi: 10.1093/ajcn/85.2.629S. PMID: 17284768.

31. King C. What‘s new in enterally feeding the preterm infant? Arch Dis Child Fetal Neonatal Ed 2010; 95(4): F304–F308. doi:10.1136/adc.2008.148197. Epub 2009 Aug 31. PMID: 19723620.

32. Walsh V, Brown JV, Copperthwaite BR, Oddie SJ, McGuire W. Early full enteral feeding for preterm or low birth weight infants. Cochrane Database Syst Rev 2020; 12: CD013542. doi:10.1002/14651858.CD013542.pub2.

33. California Perinatal Quality Care Collaborative. (2008, December). Nutritional support of the very low birth weight (VLBW) infant: A quality improvement toolkit (Revised 2008). Stanford, CA: California Perinatal Quality Care Collaborative.

34. Cobb BA, Carlo WA, Ambalavanan N. Gastric residuals and their relationship to necrotizing enterocolitis in very low birth weight infants. Pediatrics 2004; 113(1 Pt 1): 50–53. doi: 10.1542/peds.113.1.50. PMID: 14702446.

35. Ewer AK, Durbin GM, Morgan ME, et al. Gastric emptying in preterm infants. Arch Dis Child Fetal Neonatal Ed 1994; 71(1): F24–F27.

36. Perrella SL, Hepworth AR, Gridneva Z, et al. Gastric emptying and curding of pasteurized donor human milk and mother‘s own milk in preterm infants. J Pediatr Gastroenterol Nutr 2015; 61(1):125–129.

37. Yigit S, Akgoz A, Memisoglu A, et al. Breast milk fortification: Effect on gastric emptying. J Matern Fetal Neonatal Med 2008; 21(11): 843–846.

38. Riskin A, Cohen K, Kugelman A, Toropine A, Said W, Bader D. The impact of routine evaluation of gastric residual volumes on the time to achieve full enteral feeding in preterm infants. J Pediatr 2017; 189 : 128–134. doi: 10.1016/j.jpeds.2017.05.054.Epub 2017 Jun 16. PMID: 28625498.

39. Parker LA, et al. Effect of gastric residual evaluation on enteral intake in extremely preterm infants. JAMA Pediatr 2019; 173(6):534–543

40. Bertino E, Giuliani F, Prandi G, Coscia A, Martano C, Fabris C. Necrotizing enterocolitis: Risk factor analysis and role of gastric residuals in very low birth weight infants. J Pediatr Gastroenterol Nutr 2009; 48(4): 437–442. doi: 10.1097/mpg.0b013e31817b6dbe. PMID: 1933093.

41. Jape G, Nettleton M, Lai CT, Nathan E, Geddes D, Simmer K, Patole S. Composition of coloured gastric residuals in extremely preterm infants: A nested prospective observational study. Nutrients 2020; 12(9): 2585. doi: 10.3390/nu12092585.

42. Aynsley-Green A, Adrian TE, Bloom SR. Feeding and the development of enteroinsular hormone secretion in the preterm infant: Effects of continuous gastric infusions of human milk compared with intermittent boluses. Acta Paediatr Scand 1982; 71(3): 379–383.

43. Dsilna A, Christensson K, Gustafsson AS, Lagercrantz H, Alfredsson L. Behavioral stress is affected by the mode of tube feeding in very low birth weight infants. Clin J Pain 2008; 24(5):447–455. doi: 10.1097/AJP.0b013e3181633fd6. PMID: 18496310.

44. Schanler RJ, Shulman RJ, Lau C. Feeding strategies for premature infants: Beneficial outcomes of feeding fortified human milk versus preterm formula. Pediatrics 1999; 103(6 Pt 1): 1150–1157. doi: 10.1542/peds.103.6.1150. PMID: 10353922.

45. Dsilna A, Christensson K, Alfredsson L, Lagercrantz H, Blennow M. Continuous feeding promotes gastrointestinal tolerance and growth in very low birth weight infants. J Pediatr 2005; 147(1): 43–49. doi: 10.1016/j.jpeds.2005.03.003. PMID:16027693.

46. Castro M, Asbury M, Shama S, et al. Energy and fat intake for preterm infants fed donor milk is significantly impacted by enteral feeding method. JPEN J Parenter Enteral Nutr 2019; 43(1):162–165.

47. Wang Y, Zhu W, Luo BR. Continuous feeding versus intermittent bolus feeding for premature infants with low birth weight: A meta-analysis of randomized controlled trials. Eur J Clin Nutr 2020; 74(5): 775–783.

48. Sadrudin Premji S, Chessell L, Stewart F. Continuous nasogastric milk feeding versus intermittent bolus milk feeding for preterm infants less than 1500 grams. Cochrane Database Syst Rev 2021; 6(6): CD001819. doi: 10.1002/14651858.CD001819.pub3. PMID: 34165778; PMCID: PMC8223964.

49. Razak A. Two-hourly versus three-hourly feeding in very low-birth-weight infants: A systematic review and meta-analysis.Am J Perinatol 2020; 37(9): 898–906.

50. Rüdiger M, Herrmann S, Schmalisch G, Wauer RR, Hammer H, Tschirch E. Comparison of 2-h versus 3-h enteral feeding in extremely low birth weight infants, commencing after birth. Acta Paediatr 2008; 97(6): 764–769. doi: 10.1111/j.1651-2227.2008.00774.x. Epub 2008 Apr 16. PMID: 18422805.

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