Splanchnic Tissue Oxygenation for Predicting Feeding Tolerance in Preterm Infants

Abstract

Background: 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. Materials and Methods: 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. Results: 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. Conclusion: 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.

Keywords

feeding tolerance near infrared spectroscopy continuous feeding preterm infants

Get full access to this article

View all access options for this article.

References

Krishnamurthy

Gupta

Debnath

Gomber

. Slow versus rapid enteral feeding advancement in preterm newborn infants 1000-1499 g: a randomized controlled trial. Acta Paediatr. 2010;99:42-46.

Leaf

Dorling

Kempley

. Early or delayed enteral feeding for preterm growth-restricted infants: a randomized trial. Pediatrics. 2012;129:e1260-e1268.

Cortez

Gupta

Amaram

Pizzino

Sawhney

Sood

. Noninvasive evaluation of splanchnic tissue oxygenation using near-infrared spectroscopy in preterm neonates. J Matern Fetal Neonatal Med. 2011;24:574-582.

Lucchini

Bizzarri

Giampietro

De Curtis

. Feeding intolerance in preterm infants: how to understand the warning signs. J Matern Fetal Neonatal Med. 2011;24:S72-S74.

Hemels

MAC

van den Hoogen

Verboon-Maciolek

Fleer

Krediet

. Prevention of neonatal late-onset sepsis associated with the removal of percutaneously inserted central venous catheters in preterm infants. Pediatr Crit Care Med. 2011;12:445-448.

Berman

Moss

. Necrotizing enterocolitis: an update. Semin Fetal Neonatal Med. 2011;16:145-150.

Fortune

Wagstaff

Petros

. Cerebro splanchnic oxygenation ratio (CSOR) using near infrared spectroscopy may be able to predict splanchnic ischaemia in neonates. Intensive Care Med. 2001;27:1410-1417.

Dani

Pratesi

Fontanelli

. Blood transfusions increase cerebral, splanchnic, and renal oxygenation in anemic preterm infants. Transfusion. 2010;50:1220-1226.

Dani

Pratesi

Barp

. Near-infrared spectroscopy measurements of splanchnic tissue oxygenation during continuous versus intermittent feeding method in preterm infants. J Pediatr Gastroenterol Nutr. 2013;56:652-656.

10.

Dave

Brion

Campbell

. Splanchnic tissue oxygenation, but not brain tissue oxygenation, increases after feeds in stable preterm neonates tolerating full bolus orogastric feeding. J Perinatol. 2009;29:213-218.

11.

Maruyama

Koizumi

. Superior mesenteric artery blood flow velocity in small for gestational age infants of very low birth weight during the early neonatal period. J Perinat Med. 2001;29:64-70.

12.

Martinussen

Brubakk

Vik

Yao

. Relationship between intrauterine growth retardation and early postnatal superior mesenteric artery blood flow velocity. Biol Neonate. 1997;71:22-30.

13.

Kempley

Gamsu

Vyas

Nicolaides

. Effects of intrauterine growth retardation on postnatal visceral and cerebral blood flow velocity. Arch Dis Child. 1991;66:1115-1118.

14.

Ehrenkranz

Walsh

Vohr

. Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia. Pediatrics. 2005;116:1353-1360.

15.

Papile

Burstein

Keffler

. Incidence and evolution of the sub-ependymal intraventricular hemorrhage: a study of infants weighing less than 1500 grams. J Pediatr. 1978;92:529-534.

16.

Bell

Ternberg

Feigin

. Neonatal necrotizing enterocolitis: therapeutic decisions based upon clinical staging. Ann Surg. 1978;187:1-12.

17.

Wardle

Yoxall

Weindling

. Determinants of cerebral fractional oxygen extraction using near infrared spectroscopy in preterm neonates. J Cereb Blood Flow Metab. 2000;20:272-279.

18.

Naulaers

Morren

Van Huffel

Casaer

Devlieger

. Cerebral tissue oxygenation index in very premature infants. Arch Dis Child Fetal Neonatal Ed. 2002;87:F189-F192.

19.

Pourcelot

. Diagnostic ultrasound for cerebral vascular disease. In: Donald

eds. Present and Future of Diagnostic Ultrasound. Rotterdam, the Netherlands: Kooyker Scientific; 1976:141-147.

20.

Moore

Wilson

Schmid

Anderson-Berry

French

Berger

. Relations between feeding intolerance and stress biomarkers in preterm infants. J Pediatr Gastroenterol Nutr. 2013;57:356-362.

21.

Pepe

Etzioni

Feng

. Phases of biomarker development for early detection of cancer. J Natl Cancer Inst. 2001;93:1054-1061.

22.

Hay

Jr.

Strategies for feeding the preterm infant. Neonatology. 2008;94:245-254.

23.

Ehrenkranz

Das

Wrage

. Early nutrition mediates the influence of severity of illness on extremely LBW infants. Pediatr Res. 2011;69:522-529.

24.

Morgan

Young

McGuire

. Delayed introduction of progressive enteral feeds to prevent necrotizing enterocolitis in very low birth weight infants. Cochrane Database Syst Rev. 2011;16:CD001970.

25.

Fang

Kempley

Gamsu

. Prediction of early tolerance to enteral feeding in preterm infants by measurement of superior mesenteric artery blood flow velocity. Arch Dis Child Fetal Neonatal Ed. 2001;85:F42-F45.

26.

Coombs

Morgan

Durbin

Booth

McNeish

. Gut blood flow velocities in the newborn: effects of patent ductus arteriosus and parenteral indomethacin. Arch Dis Child. 1990;65:67-71.

27.

Petrova

Bhatt

Mehta

. Regional tissue oxygenation in preterm born infants in association with echocardiographically significant patent ductus arteriosus. J Perinatol. 2011;31:460-464.

28.

Bhatt

Petrova

Mehta

. Does treatment of patent ductus arteriosus with cyclooxygenase inhibitors affect neonatal regional tissue oxygenation? Pediatr Cardiol. 2012;33:1307-1314.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.21 MB