Feeding preterm neonates with patent ductus arteriosus (PDA): intestinal blood flow characteristics and clinical outcomes

Havranek, Thomas; Rahimi, M.; Hall, Heather; Armbrecht, Eric S.

doi:10.3109/14767058.2014.923395

Cited by 48 publications

(39 citation statements)

References 27 publications

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“…This could be ascribed to the small amount of enteral feeds these infants received in proportion to total fluids as well as the small sample size. The effect of PDA and ductal steel on the SMA blood flow is well recognized; 30,31 since almost all infants in this study had PDA, we were not able to analyze the bearing of PDA on the SMA blood flow velocities.…”

Section: Discussionmentioning

confidence: 90%

Effect of blood transfusion on intestinal blood flow and oxygenation in extremely preterm infants during first week of life

2015

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Section: Discussionmentioning

confidence: 90%

Effect of blood transfusion on intestinal blood flow and oxygenation in extremely preterm infants during first week of life

2015

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“…A similar trial was performed in extremely low birth weight infants by Havranek et al in 2015 [57]. Pre-and post-prandial time-averaged mean, peak-systolic, and end-diastolic velocity in SMA were measured in preterm infants aged 5-7 days.…”

Section: Impact On Hemodynamics Response To Feedsmentioning

confidence: 97%

“…Similarly, this group showed reduced SrSO 2 and SCOR patterns before and after feeding administration, but the between-group comparison did not reach statistical significance at any time point. The small study sample of these trials [57,59], however, may have limited the power of the study analysis and the observed non-significant results.…”

Section: Impact On Hemodynamics Response To Feedsmentioning

confidence: 99%

“…The number of days required to reach enteral intakes ≥ 150 mL/kg/day in relation to the ductal status was also evaluated as a marker for feeding tolerance by Havranek et al [57]. Preterm infants in the large PDA group (PDA/LPA ≥ 1) required a significantly longer period to achieve FEF compared to those with moderate (PDA/LPA ratio ≥ 0.5 but <1) and small (PDA/LPA ratio < 0.5) or closed ductus (p = 0.02).…”

Section: Association Between Pda Feeding Practices and Gi Outcomesmentioning

confidence: 99%

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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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“…(45)(46)(47) The effects of a hemodynamically significant PDA on superior mesenteric artery (SMA) blood flow have been examined, with some correlation seen in Doppler blood flow velocity parameters. (47)(48) SMA blood flow response has been noted to be blunted in the presence of a PDA in baboons and human infants (49)(50). …”

mentioning

confidence: 97%

Influences of Feeding on Necrotizing Enterocolitis

Thompson-Branch

Havranek

2018

NeoReviews

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Despite the recognition that enteral feeding and some clinical conditions encountered during the management of prematurity may affect the development of necrotizing enterocolitis (NEC) in premature neonates, there is still significant variation in practice. Clinicians should be aware of the current evidence regarding feeding and the development of NEC in premature neonates, specifically relating to the use of breast milk, feeding when a patent ductus arteriosus is present and during its treatment, as well as the potential association of NEC with anemia and red blood cell transfusions. AbstractNecrotizing enterocolitis (NEC) remains one of the leading complications of prematurity with an incidence of 5% to 13% and a mortality of up to 30%. Its occurrence is inversely related to gestational age, with the most premature neonates being at highest risk. Despite numerous studies assessing risk factors, the most commonly observed associations remain prematurity and enteral feeding. Furthermore, studies have pointed to receipt of breast milk as a protective factor in decreasing the risk of NEC and formula feeding as potentially increasing the risk. Other potential risk factors and associations in the premature infant include lack of antenatal steroids, receipt of prolonged courses of postnatal antibiotics, presence of anemia, receipt of packed red blood cell transfusions, and presence of a patent ductus arteriosus. Despite the recognition that NEC remains a serious complication of prematurity, there is still no specific prescription for its prevention. Given that enteral feeding is one of the most commonly observed risk factors for the development of NEC, wide variation exists in the enteral feeding recommendations and practices for premature infants. Feeding practices that may contribute to NEC, which remain variable in practice, include feeding strategies used in the presence of a hemodynamically significant patent ductus arteriosus and feeding during packed red blood cell transfusions. Use of breast milk (mother's own milk or donor milk) is recognized as one of the mainstays of NEC prevention. This article explores multiple influences of feeding on the development of NEC.

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Feeding preterm neonates with patent ductus arteriosus (PDA): intestinal blood flow characteristics and clinical outcomes

Abstract: ELBW preterm neonates with large PDA may have attenuated intestinal blood flow responses to feedings. There was also an association with higher rates of necrotizing enterocolitis and feeding intolerance in the large PDA group.

Cited by 48 publications

References 27 publications

Effect of blood transfusion on intestinal blood flow and oxygenation in extremely preterm infants during first week of life

Effect of blood transfusion on intestinal blood flow and oxygenation in extremely preterm infants during first week of life

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

Influences of Feeding on Necrotizing Enterocolitis

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