Trophic feedings for parenterally fed infants

Tyson, Jon E.; Kennedy, Kathleen A.

doi:10.1002/14651858.cd000504.pub2

Cited by 146 publications

(72 citation statements)

References 20 publications

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“…EEF might have prevented severe atrophy in intestine developing within 3 days of starvation, as shown in animal studies (Hughes and Doweling, 1980). Cochrane cautiously approaches early trophic feedings of VLBW infants by stating that even when trophic feedings were compared to no feedings, the relative risk for NEC was 1.16 (0.75-1.79) (Tyson and Kennedy, 2005). Contrarily, the incidence of NEC did not increase in the EEF group in our study.…”

Section: Discussionsupporting

confidence: 61%

Does early enteral feeding of very low birth weight infants increase the risk of necrotizing enterocolitis?

2007

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Section: Discussionsupporting

confidence: 61%

Does early enteral feeding of very low birth weight infants increase the risk of necrotizing enterocolitis?

2007

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“…Although the ultimate etiology of NEC remains unknown, studies have shown that certain feeding practices may be associated with decreased NEC rates. Although trophic feedings, or the provision of small volume, nutritionally insufficient feeds, have not been statistically associated with decreased NEC rates in systematic reviews, 20,21 they have been shown to stimulate gastrointestinal development [22][23][24][25] and promote gut motility 26 in premature infants. Studies have also shown a benefit to the use of human milk as the primary nutritional substrate for premature infants, with significant decreases in NEC rate associated with increased use of breast milk, both mother's own and donor.…”

Section: Discussionmentioning

confidence: 99%

Improved outcomes with a standardized feeding protocol for very low birth weight infants

et al. 2011

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Objective: The objective of this study was to evaluate the impact of a standardized enteral feeding protocol for very low birth weight (VLBW) infants on nutritional, clinical and growth outcomes.Study Design: Retrospective analysis of VLBW cohorts 9 months before and after initiation of a standardized feeding protocol consisting of 6-8 days of trophic feedings, followed by an increase of 20 ml/kg/day. The primary outcome was days to reach full enteral feeds defined as 160 ml/ kg/day. Secondary outcomes included rates of necrotizing enterocolitis and culture-proven sepsis, days of parenteral nutrition and growth end points.Result: Data were analyzed on 147 VLBW infants who received enteral feedings, 83 before ('Before') and 64 subsequent to ('After') feeding protocol initiation. Extremely low birth weight (ELBW) infants in the After group attained enteral volumes of 120 ml/kg/day (43.9 days Before vs 32.8 days After, P ¼ 0.02) and 160 ml/kg/day (48.5 days Before vs 35.8 days After, P ¼ 0.02) significantly faster and received significantly fewer days of parenteral nutrition (46.2 days Before vs 31.3 days After, P ¼ 0.01). Necrotizing enterocolitis decreased in the After group among VLBW (15/83, 18% Before vs 2/64, 3% After, P ¼ 0.005) and ELBW infants (11/31, 35% Before vs 2/26, 8% After, P ¼ 0.01). Late-onset sepsis decreased significantly in the After group (26/83, 31% Before vs 6/64, 9% After, P ¼ 0.001). Excluding those with weight <3rd percentile at birth, the proportion with weight <3rd percentile at discharge decreased significantly after protocol initiation (35% Before vs 17% After, P ¼ 0.03).Conclusion: These data suggest that implementation of a standardized feeding protocol for VLBW infants results in earlier successful enteral feeding without increased rates of major morbidities.

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“…Enteral feedings, even small volumes with minimal caloric value, appear to be important for the stimulation of enterohepatic function. 5,36,37 In the absence of feedings, hormone levels of gastrin and cholecystokinin are reduced, decreasing bile transport. Our data supported the importance of early enteral feedings.…”

Section: Discussionmentioning

confidence: 99%

Demographic and nutritional factors associated with prolonged cholestatic jaundice in the premature infant

et al. 2007

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Objective: The primary aim of this study was to determine if an association exists between amino-acid levels and development of cholestasis. The secondary aim of our amino-acid dose comparison trial was to identify factors associated with the development of prolonged cholestatic jaundice.Study Design: We compared demographic characteristics and amino-acid levels in neonates who developed cholestasis with those who did not. Parenteral-associated cholestatic liver disease was defined as a direct serum bilirubin above 5 mg per 100 ml any time during the first 28 days after birth in neonates with no history of biliary atresia or viral hepatitis. We obtained filter paper blood spots for amino acid and acylcarnitine measurements on the day of randomization and days 7 and 28 of age to identify a profile of values that could be used to identify neonates with evidence of abnormal liver function. Result:We enrolled 122 neonates in our study; 13 (10.7%) developed cholestasis. Neonates who developed cholestasis were more immature, had lower birth weight, were exposed to parenteral nutrition for a longer period, had a higher cumulative dose of amino acids, were less often on enteral nutrition by day 7 of age, more often had a patent ductus arteriosus and severe intraventricular hemorrhage and were more commonly treated with steroids by 28 days of age. Amino acid and acylcarnitine values were not different for the two groups on the day of randomization. On day 7 (parenteral phase of nutrition), blood urea nitrogen, citrulline, histidine, methionine and succinyl carnitine were higher, and serine, glutamate and thyroxine levels were lower in the neonates who developed cholestasis than in who did not. Conclusion:Cholestasis remains an important complication of parenteral nutrition, and several clinical and biochemical factors may be helpful in identifying high-risk patients.

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Trophic feedings for parenterally fed infants

Cited by 146 publications

References 20 publications

Does early enteral feeding of very low birth weight infants increase the risk of necrotizing enterocolitis?

Does early enteral feeding of very low birth weight infants increase the risk of necrotizing enterocolitis?

Improved outcomes with a standardized feeding protocol for very low birth weight infants

Demographic and nutritional factors associated with prolonged cholestatic jaundice in the premature infant

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