Near‐Infrared Spectroscopy Measurements of Splanchnic Tissue Oxygenation During Continuous Versus Intermittent Feeding Method in Preterm Infants

Dani, Carlo; Pratesi, Simone; Barp, Jacopo; Bertini, Giovanna; Gozzini, Elena; Mele, Laura; Parrini, Letizia

doi:10.1097/mpg.0b013e318287e9d7

Cited by 37 publications

(35 citation statements)

References 41 publications

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“…We used the CSOR for comparison because it is more reliable than splanchnic oxygenation value alone, and has been proposed as marker of abnormal perfusion processes affecting the gastrointestinal tract. 24 Similar to previous studies, [43][44][45] in the present study brain tissue oxygenation remained stable following feedings. This stability is likely attributed to the physiological mechanism of cerebral self-regulation, which maintains cerebral blood flow and oxygen delivery at almost constant levels.…”

Section: Discussionsupporting

confidence: 93%

Impact of Continuous vs Bolus Feeding on Splanchnic Perfusion in Very Low Birth Weight Infants: A Randomized Trial

Bozzetti

Paterlini

Lorenzo

et al. 2016

The Journal of Pediatrics

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Section: Discussionsupporting

confidence: 93%

Impact of Continuous vs Bolus Feeding on Splanchnic Perfusion in Very Low Birth Weight Infants: A Randomized Trial

Bozzetti

Paterlini

Lorenzo

et al. 2016

The Journal of Pediatrics

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“…Similarly, a significant increase in splanchnic oxygenation values, detected by NIRS, has been documented (19,21), consistently with the previously described hemodynamic changes (20). It has been suggested that these variations may be due to the cyclic release of gastrointestinal hormones, such as gastrin, enteroglucagon, and gastric inhibitory peptide, specifically promoted by intermittent bolus feeding (3).…”

Section: Articlessupporting

confidence: 64%

“…In line with this finding, a concomitant increase in splanchnic oxygenation, evaluated by means of NIRS, has been described (19)(20)(21). On the other hand, data about hemodynamic and tissue oxygenation changes related to continuous feeding are scarce, as are data documenting differences between cerebral and splanchnic oxygenation related to continuous feeding.…”

mentioning

confidence: 74%

“…Dave et al (19) documented a significant increase in splanchnic TOI values in stable preterm infants 1 h after bolus feeding; similarly, Dani et al (21) showed a relevant increase in splanchnic oxygenation as early as 30 min from bolus administration. Consistently with previous studies, our results confirm a postprandial increase in splanchnic oxygenation, occurring from 1 h and 10 min onward.…”

Section: Articlesmentioning

confidence: 99%

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Bolus vs. continuous feeding: effects on splanchnic and cerebral tissue oxygenation in healthy preterm infants

et al. 2014

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Background: Intermittent and continuous tube feeding modes are commonly used to feed preterm infants. However, there is no clear evidence regarding which method is better tolerated. We investigated the differences between bolus and continuous feeding in terms of cerebral and splanchnic oxygenation in healthy preterm infants. Methods: Thirty preterm infants underwent a simultaneous 6-h near-infrared-spectroscopy monitoring of cerebral and splanchnic oxygenation, during which they were fed twice through an orogastric tube: one meal was given as a 10-min bolus, and the other was given continuously over a period of 3 h. Oxygenation trends over time were evaluated and compared between bolus and continuous feeding modes. results: Cerebral oxygenation did not change over time and did not differ between the two feeding techniques. Splanchnic oxygenation changed significantly over time and differed between the two feeding techniques, with a significant increase after bolus feeding and a remarkable reduction during continuous feeding. conclusion: Bolus and continuous feeding modes influence splanchnic oxygenation in healthy preterm infants differently. Further studies are needed to investigate possible underlying mechanisms and potential effects on feeding tolerance.n eonatal care has substantially improved over the past decades, leading to a significant increase in the survival rate of very preterm infants (1). Enteral nutrition is essential for the development of the gastrointestinal tract in the preterm population because it improves intestinal motor activity (2), enhances the release of gastrointestinal hormones with trophic effects (3), and ameliorates feeding tolerance (4). However, very preterm infants are unable to coordinate sucking, swallowing, and breathing (5); thus, they are usually fed via an intragastric tube, continuously or through intermittent boluses (6). Differences between continuous and bolus tube feeding in terms of weight gain, days to full enteral feeding achievement, feeding tolerance, and effect on necrotizing enterocolitis have been largely investigated. Currently, however, there is no clear evidence regarding the method that is better tolerated (7). The effect of the two feeding techniques on cerebral and splanchnic oxygenation has not been extensively investigated. Regional tissue oxygenation results from a dynamic balance between oxygen supply and consumption; thus, a reduction in this parameter might reflect an impairment of systemic oxygen saturation (e.g., due to the occurrence of apneic episodes (8)), a decreased cardiac output leading to a reduction of peripheral perfusion (9), a hemodynamic variation within the examined tissue (e.g., regional vasoconstriction/vasodilatation), or a higher oxygen consumption required to satisfy the metabolic demand (10).Near-infrared spectroscopy (NIRS) is a noninvasive technique based on the near-infrared light absorption spectra of cytochromes, which provides a continuous monitoring of regional tissue oxygenation by measuring the levels of oxygenated a...

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“…Some few, of small size and not randomized, studies assessing the impact of different modalities of feeding (bolus versus continuous feeding) on splanchnic oxygenation were performed and they 35 demonstrated that bolus milk feeding induces an increase in splanchnic oxygenation without increasing oxygen blood extraction in both healthy AGA and SGA infants, whereas continuous feeding does not affect gastrointestinal oxygenation. Corvaglia et al 36 reported a significant decrease of splanchnic oxygenation occurring in the second half of continuous feeding and a slight trend toward increase in splanchnic Tissue Oxygenation Index during the final 10 minutes of continuous feeding.…”

Section: Resultsmentioning

confidence: 99%

Enteral nutrition for preterm infants: by bolus or continuous? An update

Bozzetti

Tagliabue

2017

Pediatr Med Chir

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Optimization of nutritional management of preterm infants is crucial for achievement of their long-term health. Enteral nutrition is preferred to total parenteral nutrition (TPN) because the former avoids complications related to vascular catheterization, sepsis, adverse effects of TPN, and fasting. Due to the lack of ability of preterm infants to coordinate suckling, swallowing, and breathing, tube feeding is necessary for most infants less than 1500 g to ensure sufficient feeding tolerance, to support optimal growth and to reduce the risk of aspiration. Therefore, feeding by orogastric or nasogastric tube using either continuous or intermittent bolus delivery of formula or human milk is common practice for these infants. Theoretical risks and benefits of both continuous nasogastric milk feeding and intermittent bolus milk feeding have been proposed. According to the literature, continuous nutrition could be preferred in smaller infants (as those with a birthweight below 1250 g) or hemodynamically impaired infants; in stable growing infants nutrition can be administered intermittently as in healthy term infants. IntroductionApproximately 8% of infants are born with a weight at birth less than 2.5 kg. 1 These infants face uncertain futures, ranging from insufficient postnatal growth to compromised neurodevelopmental outcomes. 2 Thus, optimization of their nutritional management is crucial for achievement of their long-term health and wellbeing. There is a correlation between the neurocognitive outcome and growth, for this reason an adequate nutrition is essential for the optimal growth and health. Most of severe preterm infants are discharged weighing less than the tenth percentile for age despite improvements in their nutritional management. 3 Some of them remain small to adulthood and exhibit adverse long-term developmental outcomes including learning impairments and reduced work capacity. 4,5 Because growth failure of low birth weight (LBW) infants has been attributed, in part, to the provision of inadequate levels of protein and energy, more aggressive nutritional support is now being advocated. 6 Evidence suggests that this approach is justified because early provision of amino acids to extremely LBW infants is associated with improved growth; 7 moreover provision of adequate amount of amino acid increases whole body protein synthesis and accretion rates in LBW infants. 8 Parenteral feeding allows rapid nutrition when enteral nutrition is not possible due to respiratory problems, limited gastric capacity, reduced intestinal mobility, and a perceived risk for necrotizing enterocolitis. 6 When an infant is medically stable, minimal enteral feeding is provided to prime the intestine and gradually the infant is moved from parenteral to enteral feeding until achievement of full enteral feedings.Enteral nutrition is preferred to total parenteral nutrition (TPN) because the former avoids complications related to vascular catheterization, sepsis, adverse effects of TPN, and fasting. Moreover, enteral feedin...

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Near‐Infrared Spectroscopy Measurements of Splanchnic Tissue Oxygenation During Continuous Versus Intermittent Feeding Method in Preterm Infants

Cited by 37 publications

References 41 publications

Impact of Continuous vs Bolus Feeding on Splanchnic Perfusion in Very Low Birth Weight Infants: A Randomized Trial

Impact of Continuous vs Bolus Feeding on Splanchnic Perfusion in Very Low Birth Weight Infants: A Randomized Trial

Bolus vs. continuous feeding: effects on splanchnic and cerebral tissue oxygenation in healthy preterm infants

Enteral nutrition for preterm infants: by bolus or continuous? An update

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