Enteral feeding during indomethacin treatment for patent ductus arteriosus: association with gastrointestinal outcomes

Louis, Deepak; Torgalkar, Ranjit; Shah, Jyotsna; Shah, Prakesh S.; Jain, Amish

doi:10.1038/jp.2016.11

Cited by 17 publications

(9 citation statements)

References 15 publications

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“…More recently, similar findings have been reported by Louis et al [65], who retrospectively investigated the prevalence of NEC stage ≥ 2a [61], feeding intolerance, defined as at least two consecutive gastric aspirates of >50% of previous feed volume or any aspirate containing bile or blood, time to enteral intakes of 120 and 160 mL/kg/day, and length of parenteral nutrition in relation to enteral feeding intakes at the time of indomethacin therapy in preterm neonates with PDA. Based on their enteral feed volume exposure during treatment, the enrolled infants were stratified into the following groups: NPO (n = 229); intake ≤ 60 mL/kg/day (n = 142); intake > 60 mL/kg/day (n = 44).…”

Section: Association Between Pda Feeding Practices and Gi Outcomessupporting

confidence: 73%

To Feed or Not to Feed: A Critical Overview of Enteral Feeding Management and Gastrointestinal Complications in Preterm Neonates with a Patent Ductus Arteriosus

et al. 2019

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The management of enteral feeds in preterm infants with a hemodynamically significant patent ductus arteriosus (hs-PDA) is a major challenge for neonatologists due to the fear of gastrointestinal (GI) complications. This review aims to analyze the available evidence on the complex relation between the presence and management of PDA, enteral feeding practices, and GI outcomes in the preterm population. There is limited evidence, based on small and heterogeneous trials, that hs-PDA may affect the splanchnic hemodynamic response to enteral feeds. While the presence of PDA seems a risk factor for adverse GI outcomes, the benefits of feeding withholding during pharmacological PDA treatment are controversial. The lack of robust evidence in support of or against a timely feeding introduction or feeding withholding during pharmacological PDA closure in preterm neonates does not allow to draw any related recommendation. While waiting for further data, the feeding management of this population should be carefully evaluated and possibly individualized on the basis of the infants’ hemodynamic and clinical characteristics. Large, multicentric trials would help to better clarify the physiological mechanisms underlying the development of gut hypoperfusion, and to evaluate the impact of enteral feeds on splanchnic hemodynamics in relation to PDA features and treatment.

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Section: Association Between Pda Feeding Practices and Gi Outcomessupporting

confidence: 73%

To Feed or Not to Feed: A Critical Overview of Enteral Feeding Management and Gastrointestinal Complications in Preterm Neonates with a Patent Ductus Arteriosus

et al. 2019

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“…Indomethacin is widely used to treat patent ductus arteriosus in human neonates ( 27 , 28 ). Previous studies have demonstrated that a partial ligation of the arterial duct in utero was able to induce PPHN in sheep ( 29 , 30 ).…”

Section: Discussionmentioning

confidence: 99%

Altered expression of PPAR-γ and TRPC in neonatal rats with persistent pulmonary hypertension

Yao

et al. 2017

Molecular Medicine Reports

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Persistent pulmonary hypertension of the newborn (PPHN) is a life-threatening disease that is commonly observed in the neonatal intensive care unit. PPHN is pathologically characterized by pulmonary vascular remodeling and, in particular, pulmonary artery smooth muscle cell (PASMC) proliferation. Decreased expression levels of peroxisome proliferator-activated receptor γ (PPAR-γ), which is a member of the nuclear receptor hormone superfamily, in combination with elevated expressions of transient receptor potential cation channel, subfamily C, member 1 (TRPC1) and TRPC6 contributes to the PASMC proliferation and excessive pulmonary vascular remodeling in adult pulmonary hypertension (PH). Whether PPAR-γ, TRPC1 and TRPC6 affect the development of vascular remodeling in PPHN model rats remains unknown. The aim of the present study was to investigate the roles of PPAR-γ, TRPC1 and TRP6 on the pathogenesis of PPHN in rats. The rat model of PPHN was established by exposure to hypoxic conditions and indomethacin treatment. Lung tissues, hearts and blood from PPHN model and Control rats were collected and examined. Parameters, including the percentage of medial wall thickness (WT %), the percentage of medial wall area (WA %), right ventricular hypertrophy (RVH) and the plasma concentration of B-type natriuretic peptide (BNP) were used to estimate the development of PPHN. The expression levels of PPAR-γ, TRPC1 and TRPC6 in lung tissues were detected by immunohistochemistry, western blotting and reverse transcription-quantitative polymerase chain reaction. Significant increases were observed in the WT %, WA %, RVH and plasma BNP in the PPHN group compare with the Control group (P<0.01). In addition, the mRNA and protein expression levels of PPAR-γ were markedly downregulated (P<0.05 vs. Control). In the PPHN group, the protein expression levels of TRPC1 and TRPC6 were higher compared to the control group; however, there was no difference in the mRNA expression levels (P>0.05). In conclusion, the present study successfully established a PPHN rat model, and the altered expressions of PPAR-γ, TRPC1 and TRPC6 in the pulmonary artery located in the lungs of newborn rats with PPHN suggested that these proteins may be important mediators of PPHN.

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“…Allow feedings with patent ductus arteriosus, even if receiving Indomethacin [55,56] Develop and implement unit-specific standardized feeding guidelines, including threshold dosing of medication (e.g., vasopressors, etc.) to determine if enteral feedings can be initiated and/or continued [28] One of the most significant barriers to initiating and advancing enteral feeding in preterm infants is clinician fear of NEC.…”

Section: Hemodynamic Instabilitymentioning

confidence: 99%

Early Enteral Feeding in Preterm Infants: A Narrative Review of the Nutritional, Metabolic, and Developmental Benefits

Thoene

Anderson‐Berry

2021

Nutrients

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Enteral feeding is the preferred method of nutrient provision for preterm infants. Though parenteral nutrition remains an alternative to provide critical nutrition after preterm delivery, the literature suggests that enteral feeding still confers significant nutritional and non-nutritional benefits. Therefore, the purpose of this narrative review is to summarize health and clinical benefits of early enteral feeding within the first month of life in preterm infants. Likewise, this review also proposes methods to improve enteral delivery in clinical care, including a proposal for decision-making of initiation and advancement of enteral feeding. An extensive literature review assessed enteral studies in preterm infants with subsequent outcomes. The findings support the early initiation and advancement of enteral feeding impact preterm infant health by enhancing micronutrient delivery, promoting intestinal development and maturation, stimulating microbiome development, reducing inflammation, and enhancing brain growth and neurodevelopment. Clinicians must consider these short- and long-term implications when caring for preterm infants.

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Enteral feeding during indomethacin treatment for patent ductus arteriosus: association with gastrointestinal outcomes

Cited by 17 publications

References 15 publications

To Feed or Not to Feed: A Critical Overview of Enteral Feeding Management and Gastrointestinal Complications in Preterm Neonates with a Patent Ductus Arteriosus

To Feed or Not to Feed: A Critical Overview of Enteral Feeding Management and Gastrointestinal Complications in Preterm Neonates with a Patent Ductus Arteriosus

Altered expression of PPAR-γ and TRPC in neonatal rats with persistent pulmonary hypertension

Early Enteral Feeding in Preterm Infants: A Narrative Review of the Nutritional, Metabolic, and Developmental Benefits

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