Early Enteral Feeding Improves Tolerance of Parenteral Nutrition in Preterm Newborns

Abstract

(1) Background: The tolerance of preterm newborns for the high nutritional intakes given by parenteral nutrition (PN) is still debated because of the risk of metabolic complications. Despite enteral nutrition (EN) being the preferred route of nutrition, an exclusive enteral feeding is not always possible, as in preterm newborns, the gut is immature and less tolerant of EN. We aimed to study the impact of a minimal enteral feeding (MEF) on the possible early metabolic complications of PN in a cohort of preterms with gestational age at birth GA ≤ 29 + 6/7 weeks of postmenstrual age. (2) Methods: We divided the study sample in two cohorts: 1) Late-Feeding (cohort 1), newborns who received MEF starting from the 8th day of age, and (2) Early-Feeding (cohort 2), newborns who received MEF, consisting of the administration of at least 4–5 mL/kg/day by the enteral route, in the first 7 days of age. The primary outcome of the study was the rate of at least one metabolic complication, including hyperglycemia, hypertriglyceridemia, or metabolic acidosis. (3) Results: We enrolled 80 newborns (Late-Feeding cohort 51 vs. Early-Feeding cohort 29). The rate of all metabolic complications was statistically higher in the Late-Feeding cohort compared to the Early-Feeding cohort. Binary logistic regression analysis showed that late administration of MEF negatively influenced the rate of all metabolic complications. (4) Conclusions: Early minimal administration of EN is associated with less frequent PN-related metabolic side effects and a higher rate of survival in critically ill newborns.

Impact of Early Nutrient Intake and First Year Growth on Neurodevelopment of Very Low Birth Weight Newborns

“…More evidence is emerging regarding the advantages of enteral nutrients over parenteral [21] and well-known benefits of enteral feeding and breastmilk on cerebral growth, brain structures, and neurodevelopment [23,47]. Moreover, the study by Boscarino et al found that early enteral feeding may improve tolerance of parenteral nutrition in preterm newborns and may prevent PN related metabolic complications, such as hyperglycemia, hypertriglyceridemia, and metabolic acidosis [25]. Early feeding with own mother's milk is now a preferred practice for very preterm infants.…”

“…More evidence suggests that early enteral nutrient and energy intake is associated with better cerebral growth, head growth, brain structure, and neurodevelopment [21,23,24]. Moreover, early enteral feeding may improve tolerance of PN [25], reducing adverse metabolic effects, such as hyperglycemia, which also may be related to neurodevelopmental impairment [26]. Thus, current nutritional strategies recommend early enteral feeding with human milk (HM) and enhanced nutrient provision with HM fortification [27,28].…”

A Scoping Review: Urinary Markers of Metabolic Maturation in Preterm Infants and Future Interventions to Improve Growth

“…Although there are well established nutritional recommendations from various expert groups pertaining to macro- and micronutrient requirements of preterm infants [ 4 , 16 ], the recommendations do not account for an individual preterm infant’s ability to assimilate nutrients or the ability to overcome potential aberrance in metabolic pathways [ 5 , 9 , 17 ]. As an example, some preterm infants, (especially those around the threshold of viability) experience metabolic immaturity and instability leading to sustained periods of hyperglycaemia and hypertriglyceridemia, meaning that some nutritional goals are not met during a time of rapid growth and organ development [ 9 , 17 ]. Current strategies to manage metabolic complications include the use of insulin (which is not without risk), or potentially an even cruder strategy of reducing the amount substrate (e.g., glucose and lipid) delivered with associated negative sequalae on macro- and micronutrient intake [ 9 , 10 , 17 , 18 ].…”

“…As an example, some preterm infants, (especially those around the threshold of viability) experience metabolic immaturity and instability leading to sustained periods of hyperglycaemia and hypertriglyceridemia, meaning that some nutritional goals are not met during a time of rapid growth and organ development [ 9 , 17 ]. Current strategies to manage metabolic complications include the use of insulin (which is not without risk), or potentially an even cruder strategy of reducing the amount substrate (e.g., glucose and lipid) delivered with associated negative sequalae on macro- and micronutrient intake [ 9 , 10 , 17 , 18 ].…”

Early oral feeding enhanced recovery after intestinal anastomosis in young infants aged less than 3 months -A real-word study

“…Intestinal anastomosis(IA) is a frequently used surgical procedure in pediatric surgery,however, no de ned initial oral feeding time was suggested to date [1,2].Traditionally,a 4-5 days of fasting or traditional oral feeding(TOF) would be chosen by pediatric surgeon to avoid dehiscence of anastomosis after intestinal anastomosis [3][4][5].Many opposite effects caused by long fasting were proven,such as atrophy of the villi, decreased activity of disaccharidase, reduction of intestinal mucosa, and intestinal microbiota dysbiosis [2,6]. In contrast,early oral feeding(EOF) could be bene cial in gut development, regeneration of the intestinal mucosal epithelium, maintenance of the integrity of the gut barrier, and prevention of bacterial translocation [7,8].…”