Minimal Enteral Feeding Induces Maturation of Intestinal Motor Function but Not Mucosal Growth in Neonatal Dogs

Abstract

Providing small enteral feedings for parenterally fed preterm infants during the first few weeks of life improves feeding tolerance. However, it is not known whether these feedings achieve this result via stimulation of gut growth and/or maturation of function. The minimal level needed to attain these responses is also critical to identify, because neonatologists often limit feeding volumes to minimize the risk of necrotizing enterocolitis. Thus, we determined the dose-response relationships between enteral feeding volume and gastrointestinal growth and small intestine motor function. Newborn canine pups (n = 51) received 0, 2.5, 5.0, 7.5, 10, 30 or 100% of their daily fluid intake enterally with the remainder given parenterally for 4-5 d. Motor activity was recorded, blood drawn for determination of gastrin and motilin, and intestinal tissue harvested for determination of DNA and protein content and morphology. Feeding volumes that provided 30% or more of daily fluid intake significantly increased small intestinal mucosal growth above that of unfed pups, but feeding volumes that provided as little as 10% of daily fluid intake significantly induced maturation of motor patterns beyond that of unfed pups. Plasma concentrations of gastrin and motilin did not differ among groups. We conclude that small enteral feedings typically used for minimal enteral feeding strategies improve feeding tolerance by triggering maturation of motor function but not gut growth in neonatal dogs. Small feeding volumes trigger this maturation as well as large volumes.

Randomized trial of initial trophic versus full-energy enteral nutrition in mechanically ventilated patients with acute respiratory failure

“…Similar to the findings in animals (28,29), these data demonstrate that initial trophic feeds, providing about 15% of goal calories daily, result in similar clinical outcomes as initial full-energy enteral nutrition. Although designed similarly to Ibrahim's study, important differences beyond the results should be noted.…”

Initial Trophic vs Full Enteral Feeding in Patients With Acute Lung Injury: The EDEN Randomized Trial

“…Although there is no agreement on a standard definition of “trophic feeding” or permissive underfeeding, we chose to provide approximately one-quarter of estimated total caloric needs based on studies in animals and low-birth-weight infants, 15,23–25 expert review by an independent protocol review committee, and our assessment of the feasibility of conducting hypocaloric feeding in a clinical context. Providing approximately 25% of goal feeding clearly resulted in less group separation than would have occurred with a “no feeding” comparator.…”

Intestinal Edema: Effect of Enteral Feeding on Motility and Gene Expression

“…Acceleration in intestinal transit is also demonstrated in Sham animals receiving IEN. Owens et al demonstrated in their neonatal enteral nutritional pup model that intestinal water weight increased as the % of enteral nutrition was increased and the migrating motor complex was greater in pups receiving more enteral nutrition compared to pups that did not receive enteral nutrition (21). This may account for the similar results since in our Sham/IEN group receiving enteral nutrition.…”