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Martini S, Meneghin F, Aceti A, Cerchierini N, Beghetti I, Lista G, Corvaglia L. Effect of different tube feeding methods on gastroesophageal reflux features in preterm infants: a pH-impedance monitoring study. Eur J Pediatr 2024:10.1007/s00431-024-05737-7. [PMID: 39212753 DOI: 10.1007/s00431-024-05737-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 08/13/2024] [Accepted: 08/17/2024] [Indexed: 09/04/2024]
Abstract
A stepwise approach is currently considered the best choice to manage gastroesophageal reflux (GER) in preterm infants. This study aimed to evaluate the effect of different tube feeding techniques on GER frequency and features in symptomatic tube-fed preterm neonates. Tube-fed infants < 34 weeks' gestation were eligible for this prospective, bicentric, cross-over study if, due to GER symptoms, they underwent a diagnostic 24-h combined pH and multiple intraluminal impedance (pH-MII) monitoring. During the monitoring period, each infant received the same feeding cycle, repeated twice: continuous tube feeding, bolus feeding followed by tube feeding permanence and by tube feeding removal. The impact of these three feeding modalities on pH-MII GER features was assessed. Thirty-one infants were enrolled. Despite a low number of reflux episodes, a significant decrease in total GERs (P < 0.001), in GERs detected by pH monitoring (P < 0.001), and in both acid and non-acid GERs detected by MII (P < 0.001 and P = 0.009, respectively) was observed in association with continuous feeding compared to bolus feeds, followed or not by tube feeding removal. Compared to continuous feeding, both bolus feeding modalities were associated with a significantly higher number of proximal GERs (P < 0.001). No difference in any pH-MII parameter was observed in relation to tube feeding persistence after bolus feeding administration. CONCLUSIONS Continuous feeding and boluses may have a different impact on pH-MII GER features in symptomatic tube-fed preterm infants, whereas the permanence of the feeding tube across LES did not seem to worsen GER indexes. WHAT IS KNOWN • Due to the functional and anatomical immaturity of the gastrointestinal tract, gastroesophageal reflux (GER) is common in preterm infants. • A stepwise therapeutical approach which firstly undertakes conservative strategies is the most advisable choice to avoid potentially harmful pharmacological overtreatments in the preterm population. WHAT IS NEW • Continuous feeding and boluses may have a different impact on GER features assessed by pH-MII monitoring in tube-fed preterm infants. • The permanence of the feeding tube during or after the feeding period did not seem to worsen GER occurrence. • By reducing GER features, especially acid GER, continuous feeding may potentially contribute to limit the need for antiacid medications in this population.
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Affiliation(s)
- Silvia Martini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Neonatal Intensive Care Unit, IRCCS AOUBO, Bologna, Italy
| | - Fabio Meneghin
- Neonatology and Neonatal Intensive Care Unit, "V. Buzzi" Children's Hospital, ASST FBF-Sacco-Buzzi, Milan, Italy
| | - Arianna Aceti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Neonatal Intensive Care Unit, IRCCS AOUBO, Bologna, Italy
| | | | - Isadora Beghetti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
- Neonatal Intensive Care Unit, IRCCS AOUBO, Bologna, Italy.
| | - Gianluca Lista
- Neonatology and Neonatal Intensive Care Unit, "V. Buzzi" Children's Hospital, ASST FBF-Sacco-Buzzi, Milan, Italy
| | - Luigi Corvaglia
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Neonatal Intensive Care Unit, IRCCS AOUBO, Bologna, Italy
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Kooi EMW, Mintzer JP, Rhee CJ, Ergenekon E, Schwarz CE, Pichler G, de Boode WP. Neonatal somatic oxygenation and perfusion assessment using near-infrared spectroscopy : Part of the series on near-infrared spectroscopy by the European Society of Paediatric Research Special Interest Group "Near-Infrared Spectroscopy". Pediatr Res 2024:10.1038/s41390-024-03226-z. [PMID: 38730022 DOI: 10.1038/s41390-024-03226-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/27/2024] [Accepted: 04/09/2024] [Indexed: 05/12/2024]
Abstract
In this narrative review, we summarize the current knowledge and applications of somatic near-infrared spectroscopy (NIRS), with a focus on intestinal, renal, limb, and multi-site applications in neonates. Assessing somatic oxygenation at various body locations in neonates may aid in the understanding of underlying pathophysiology of organ injury. Considering cerebral autoregulation may be active to protect the brain during systemic circulatory failure, peripheral somatic oxygenation may potentially provide an early indication of neonatal cardiovascular failure and ultimate hypoxemic injury to vital organs including the brain. Certain intestinal oxygenation patterns appear to be associated with the onset and course of necrotizing enterocolitis, whereas impaired renal oxygenation may indicate the onset of acute kidney injury after various types of hypoxic events. Peripheral muscle oxygenation measured at a limb may be particularly effective in the early prediction of shock in neonates. Using multi-site NIRS may complement current approaches and clinical investigations to alert for neonatal tissue hypoxemia, and potentially even guide management. However, somatic NIRS has its inherent limitations in regard to accuracy. Interpretation of organ-specific values can also be challenging. Last, currently there are limited prospective intervention studies, and clinical benefits need to be examined further, after the clarification of critical threshold-values. IMPACT: The assessment of somatic oxygenation using NIRS may contribute to the prediction of specific diseases in hemodynamically challenged neonates. Furthermore, it may give early warning signs for impending cardiovascular failure, and impaired cerebral circulation and oxygenation. We present a comprehensive overview of the literature on applications of NIRS to various somatic areas, with a focus on its potential clinical applicability, including future research directions. This paper will enable prospective standardized studies, and multicenter collaboration to obtain statistical power, likely to advance the field.
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Affiliation(s)
- Elisabeth M W Kooi
- Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Jonathan P Mintzer
- Division of Newborn Medicine, Department of Pediatrics, Mountainside Medical Center, Montclair, NJ, USA
| | | | | | - Christoph E Schwarz
- Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
- Department of Neonatology, Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Gerhard Pichler
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Willem P de Boode
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
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Lembo C, El-Khuffash A, Fusch C, Iacobelli S, Lapillonne A. Nutrition of the preterm infant with persistent ductus arteriosus: existing evidence and practical implications. Pediatr Res 2023:10.1038/s41390-023-02754-4. [PMID: 37563451 DOI: 10.1038/s41390-023-02754-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/01/2023] [Accepted: 07/09/2023] [Indexed: 08/12/2023]
Abstract
The persistence of a patent ductus arteriosus (PDA) is a common condition in preterm infants with a prevalence inversely proportional to gestational age. PDA is associated with mild-to-severe gastrointestinal complications such as feeding intolerance, gastrointestinal perforation, and necrotizing enterocolitis, which represent a major challenge for the nutritional management in preterm infants. In this context, the Section on Nutrition, Gastroenterology and Metabolism and the Circulation Section of the European Society for Pediatric Research have joined forces to review the current knowledge on nutritional issues related to PDA in preterm infants. The aim of the narrative review is to discuss the clinical implications for nutritional practice. Because there is little literature on postnatal nutrition and PDA in preterm infants, further research with well-designed studies on this topic is urgently needed. Guidelines should also be developed to clearly define the implementation and course of enteral nutrition and the target nutritional intake before, during, and after pharmacologic or surgical treatment of PDA, when indicated. IMPACT: Persistent ductus arteriosus (PDA) is associated with gastrointestinal complications such as feeding intolerance, gastrointestinal perforation, and necrotizing enterocolitis, which pose a major challenge to the nutritional management of preterm infants. In PDA infants, fluid restriction may lead to inadequate nutrient intake, which may negatively affect postnatal growth and long-term health. The presence of PDA does not appear to significantly affect mesenteric blood flow and splanchnic oxygenation after enteral feedings. Initiation or maintenance of enteral nutrition can be recommended in infants with PDA.
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Affiliation(s)
- Chiara Lembo
- Department of Neonatology, APHP, Necker-Enfants Malades Hospital, Paris, France
| | - Afif El-Khuffash
- Department of Pediatrics (School of Medicine), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Christoph Fusch
- Neonatology, Department of Pediatrics, General Hospital, Paracelsus Medical School, Nuernberg, Germany
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Silvia Iacobelli
- Réanimation Néonatale et Pédiatrique, CHU La Réunion, Saint-Pierre, France
| | - Alexandre Lapillonne
- Department of Neonatology, APHP, Necker-Enfants Malades Hospital, Paris, France.
- EHU 7328 PACT, Paris Cite University, Paris, France.
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Surmeli Onay O, Velipasaoğlu M, Tutal M, Sarılar TD, Cakıl Saglık A, Bilgin M, Aydemir O, Barsan Kaya T, Tanır HM, Tekin AN. The effect of drip versus intermittent feeding on splanchnic oxygenation in preterm infants with intrauterine growth restriction: a prospective randomized trial. Eur J Pediatr 2023; 182:1317-1328. [PMID: 36637540 DOI: 10.1007/s00431-023-04810-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/14/2023]
Abstract
The main purpose of this study was to evaluate the impact of drip versus intermittent feeding on splanchnic oxygenation in preterm infants with intrauterine growth restriction. The second objective was to assess the relationship between fetal splanchnic circulation parameters and splanchnic oxygenation during the first week of life. A single-center, prospective, randomized study with 51 fetuses/infants was conducted. Fetal Doppler measurements including umbilical artery, middle cerebral artery, and superior mesenteric artery (SMA) were recorded in IUGR fetuses. After preterm delivery, the infants were randomly assigned to one of two feeding modalities: drip (3-h continuous) or intermittent (bolus in 10 min). Continuous regional splanchnic saturation (rSO2S) monitoring was carried out during the first week of life, simultaneously with continuous oxygen arterial saturation (SaO2) monitoring, and the infants' fractional oxygen extractions (FOE) were calculated. These parameters were evaluated as means on a daily basis for the first week of life, as well as pre-prandial and post-prandial measurements on the seventh day. Fetal Doppler flow velocimetry disturbances were present in 72.5% of the study cohort. The drip (26 infants) and intermittent (25 infants) groups were similar in demographic and clinical characteristics, as well as the prevalence of feeding intolerance and necrotizing enterocolitis. During the first week of life, there was no difference in daily mean rSO2S and FOE values between the drip and intermittent groups, whereas unfed infants had mostly lower rSO2S values. Pre-prandial and post-prandial rSO2S values remained stable in both groups. Also, no association was detected between fetal splanchnic circulation parameters and neonatal splanchnic oxygenation. RSO2S values were strongly correlated to gestational age and birth weight. During the whole week, except for the first 2 days, infants with umbilical catheters had significantly lower rSO2S values than infants without. Conclusion: Our data suggest that the key factor in splanchnic oxygenation is feeding, not the feeding modality. In addition, the umbilical vein catheter had a negative impact on splanchnic oxygenation. Clinical Trial Registration: The Effect of Neonatal Feeding Modalities on Splanchnic Oxygenation, NCT05513495, https://clinicaltrials.gov/ct2/results cond=&term=NCT05513495&cntry=TR&state=&city=&dist= . Retrospectively registered, date of registration: August 2022. What is Known: • It is known that preterm infants with IUGR are at increased risk of hypoxic-ischemic intestinal damage and impaired splanchnic oxygenation. What is New: • The key factor in splanchnic oxygenation of preterm infants with IUGR is feeding, not the feeding modality (drip or intermittent). • In addition, the umbilical vein catheter had a negative impact on splanchnic oxygenation.
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Affiliation(s)
- Ozge Surmeli Onay
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
| | - Melih Velipasaoğlu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Merve Tutal
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Tevhide Derya Sarılar
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Adviye Cakıl Saglık
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Muzaffer Bilgin
- Department of Biostatistics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ozge Aydemir
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Tugba Barsan Kaya
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Huseyin Mete Tanır
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ayşe Neslihan Tekin
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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Kiran Kumar Balegar V, Jayawardhana M, de Chazal P, Nanan RKH. Splanchnic-cerebral oxygenation ratio associated with packed red blood cell transfusion in preterm infants. Transfus Med 2022; 32:475-483. [PMID: 36222235 DOI: 10.1111/tme.12919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/29/2022] [Accepted: 09/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Splanchnic-cerebral oxygenation ratio (SCOR), the ratio of splanchnic tissue oxygen (StO2 s) to simultaneously measured cerebral tissue oxygen (StO2 c), has been described as a surrogate to detect impaired splanchnic oxygenation associated with hypoperfusion status such as necrotizing enterocolitis. This concept is based on the presumption that any change in SCOR indicates a corresponding change in splanchnic tissue oxygenation as the numerator, whereas cerebral tissue oxygenation as the denominator remains stable. However, it is questionable to utilise this concept to detect splanchnic oxygenation changes in the context of packed red blood cell transfusion (PRBCT). AIM The current study examines the contribution of both cerebral and splanchnic oxygenation components to PRBCT-associated SCOR changes in preterm infants. DESIGN Prospective cohort study. SETTING Neonatal intensive care. PATIENTS Hemodynamically stable infants: Gestation <32 weeks; birth weight <1500 g; postmenstrual age <37 weeks: tolerating ≥120 ml/kg/day feed volume. INTERVENTIONS PRBCT at 15 ml/kg, over 4 h. MAIN OUTCOME MEASURES Transfusion-associated changes were determined by performing mixed models for repeated measures analysis between the 4-h mean pre-transfusion values (SCOR 0, StO2 s 0, and StO2 c 0) and the post-transfusion hourly mean values for the next 28 h (SCOR 1-28, StO2 s 1-28, and StO2 c 1-28). Dunnett's method was used to adjust for the multiplicity of the p value. RESULTS Of 30 enrolled infants 14 [46.7%] male; median [IQR] birth weight, 923 [655-1064] g; gestation, 26.4 [25.5-28.1] weeks; enrolment weight, 1549 [1113-1882] g; and postmenstrual age, 33.6 [32.4-35.0] weeks, one infant was excluded because of corrupted NIRS data. With the commencement of PRBCT, SCOR demonstrated a downward trend throughout the study period. This drift was associated with an increasing StO2 c trend, while StO2 s remained unchanged throughout the study period. CONCLUSIONS AND RELEVANCE PRBCT-associated SCOR decrease suggests improvement in cerebral oxygenation rather than worsening splanchnic oxygenation. Our study underlines that it is necessary to determine individual components of SCOR, namely cerebral and splanchnic StO2 to understand SCOR changes in the context of PRBCT.
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Affiliation(s)
- V Kiran Kumar Balegar
- Department of Neonatology, Nepean Hospital, Sydney Medical School Nepean, The University of Sydney, Sydney, Australia
| | - Madhuka Jayawardhana
- School of Electrical Engineering, Charles Perkins Center, The University of Sydney, Sydney, Australia
| | - Philip de Chazal
- School of Biomedical Engineering, Charles Perkins Center, The University of Sydney, Sydney, Australia
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Sirota GL, Litmanovitz I, Vider C, Arnon S, Moore SS, Grinblatt E, Levkovitz O, Bauer Rusek S. Regional Splanchnic Oxygenation during Continuous versus Bolus Feeding among Stable Preterm Infants. CHILDREN 2022; 9:children9050691. [PMID: 35626866 PMCID: PMC9139727 DOI: 10.3390/children9050691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/24/2022] [Accepted: 05/03/2022] [Indexed: 11/16/2022]
Abstract
Introduction: There is no agreement regarding the best method for tube-feeding preterm infants. Few studies, to date, have evaluated the influence of different methods of enteral feeding on intestinal oxygenation. The use of near-infrared spectroscopy (NIRS) has permitted the noninvasive measurement of splanchnic regional oxygenation (rSO2S) in different clinical conditions. The aim of this prospective, single-center study was to compare rSO2S during continuous versus bolus feeding among stable preterm infants. Methods: Twenty-one preterm infants, less than 32 weeks gestation and appropriate for gestational age, were enrolled. All infants were clinically stable and on full tube feedings. Each infant received a bolus feeding initially (20 min duration), and after 3 h, a continuous feeding (5 h duration). Infants were evaluated 30 min before and 30 min after the bolus and continuous feedings. The regional splanchnic saturation (rSO2S) was measured using near-infrared spectroscopy (NIRS) technology and systemic saturation was measured with pulse oximetry. From these measurements, we calculated the splanchnic fractional oxygen extraction ratio (FOES) for each of the four intervals. Results: rSO2S decreased after continuous vs. bolus feeding (p = 0.025), while there was a trend toward decreased SaO2 after bolus feeding (p = 0.055). The FOES, which reflects intestinal oxygen extraction, was not affected by the feeding mode (p = 0.129). Discussion/Conclusion: Continuous vs. bolus feeding decreases rSO2S but does not affect oxygen extraction by intestinal tissue; after bolus feeding there was a trend towards decreased systemic saturation.
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Affiliation(s)
- Gisela Laura Sirota
- Department of Neonatology, Meir Medical Center, Kfar-Saba 4428164, Israel; (I.L.); (S.A.); (S.S.M.); (E.G.); (O.L.); (S.B.R.)
- Correspondence: ; Tel.: +972-50-538-2266
| | - Ita Litmanovitz
- Department of Neonatology, Meir Medical Center, Kfar-Saba 4428164, Israel; (I.L.); (S.A.); (S.S.M.); (E.G.); (O.L.); (S.B.R.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Carmel Vider
- Department of Pediatrics, Meir Medical Center, Kfar-Saba 4428164, Israel;
| | - Shmuel Arnon
- Department of Neonatology, Meir Medical Center, Kfar-Saba 4428164, Israel; (I.L.); (S.A.); (S.S.M.); (E.G.); (O.L.); (S.B.R.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Shiran Sara Moore
- Department of Neonatology, Meir Medical Center, Kfar-Saba 4428164, Israel; (I.L.); (S.A.); (S.S.M.); (E.G.); (O.L.); (S.B.R.)
| | - Eynit Grinblatt
- Department of Neonatology, Meir Medical Center, Kfar-Saba 4428164, Israel; (I.L.); (S.A.); (S.S.M.); (E.G.); (O.L.); (S.B.R.)
| | - Orly Levkovitz
- Department of Neonatology, Meir Medical Center, Kfar-Saba 4428164, Israel; (I.L.); (S.A.); (S.S.M.); (E.G.); (O.L.); (S.B.R.)
| | - Sofia Bauer Rusek
- Department of Neonatology, Meir Medical Center, Kfar-Saba 4428164, Israel; (I.L.); (S.A.); (S.S.M.); (E.G.); (O.L.); (S.B.R.)
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Howarth C, Banerjee J, Leung T, Aladangady N. Could Near Infrared Spectroscopy (NIRS) be the new weapon in our fight against Necrotising Enterocolitis? Front Pediatr 2022; 10:1024566. [PMID: 36425397 PMCID: PMC9679512 DOI: 10.3389/fped.2022.1024566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022] Open
Abstract
There is no ideal single gut tissue or inflammatory biomarker available to help to try and identify Necrotising Enterocolitis (NEC) before its clinical onset. Neonatologists are all too familiar with the devastating consequences of NEC, and despite many advances in neonatal care the mortality and morbidity associated with NEC remains significant. In this article we review Near Infrared Spectroscopy (NIRS) as a method of measuring regional gut tissue oxygenation. We discuss its current and potential future applications, including considering its effectiveness as a possible new weapon in the early identification of NEC.
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Affiliation(s)
- Claire Howarth
- Neonatal Unit, Homerton Healthcare NHS Foundation Trust, London, United Kingdom
| | - Jayanta Banerjee
- Neonatal Unit, Imperial College Healthcare NHS Trust and Imperial College London, London, United Kingdom
| | - Terence Leung
- Department of Medical Physics and Biomedical Engineering, Faculty of Engineering Sciences, University College London, London, United Kingdom
| | - Narendra Aladangady
- Neonatal Unit, Homerton Healthcare NHS Foundation Trust, London, United Kingdom.,Barts and The London School of Medicine and Dentistry, Queen Mary University of London (QMUL), London, United Kingdom
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Dani C, Coviello C, Montano S, Remaschi G, Petrolini C, Strozzi MC, Maggiora E, Sabatini M, Gazzolo D. Effect on splanchnic oxygenation of breast milk, fortified breast milk, and formula milk in preterm infants. Pediatr Res 2021; 89:171-174. [PMID: 32380507 DOI: 10.1038/s41390-020-0935-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/06/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Enteral feeding induces mesenteric hemodynamic changes in preterm infants, which may vary according to the milk used. Our aim in this study was to evaluate changes of splanchnic regional oxygenation (rSO2S) measured by near-infrared spectroscopy (NIRS) in infants fed with mother's own milk (MOM), fortified human milk (FHM), or preterm formula (PTF). METHODS Infants born at 25-31 weeks of gestational age (n = 54) received a bolus of MOM, FHM, or PTF. rSO2S and splanchnic fractional oxygen extraction ratio (FOES) were recorded 60 min before (T0), and 30 min (T1) and 120 min (T2) after the beginning of bolus feeding. RESULTS In the MOM group, rSO2S and FOES did not change during the study period. In the FBM group, rSO2S decreased from T0 to T1 and increased from T1 to T2, while FOES changed in reverse. In the PTF group, rSO2S decreased from T0 to T1 and from T1 to T2, while FOES changed in reverse. CONCLUSIONS Splanchnic oxygenation was not affected by MOM feeding, was transiently decreased by FBM feeding, and was persistently decreased by PTF. These results suggest that preterm infants who received PTF has higher splanchnic tissue oxygen extraction compared to those who received MOM or FBM. IMPACT Human milk feeding is associated to a lower splanchnic energy expenditure than preterm formula feeding. Fortified human milk transiently increases splanchnic energy expenditure. Preterm formula should be used only in the absence of human milk.
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Affiliation(s)
- Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy. .,Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Florence, Italy.
| | - Caterina Coviello
- Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Florence, Italy
| | - Simona Montano
- Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Florence, Italy
| | - Giulia Remaschi
- Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Florence, Italy
| | - Chiara Petrolini
- Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Florence, Italy
| | | | - Elena Maggiora
- AO SS Antonio, Biagio and C. Arrigo Hospital, Alessandria, Italy
| | - Miriam Sabatini
- AO SS Antonio, Biagio and C. Arrigo Hospital, Alessandria, Italy
| | - Diego Gazzolo
- Neonatal Intensive Care Unit G. D'Annunzio University of Chieti, Chieti, Italy
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Goldshtrom N, Isler JR, Sahni R. Comparing liver and lower abdomen near-infrared spectroscopy in preterm infants. Early Hum Dev 2020; 151:105194. [PMID: 33017708 DOI: 10.1016/j.earlhumdev.2020.105194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/10/2020] [Accepted: 09/16/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Near-infrared spectroscopy (NIRS) is being increasingly used to investigate regional oxygenation (rSO2) and perfusion in areas such as the abdomen in preterm infants prone to feeding intolerance. Lower abdominal rSO2 values are extremely variable, high sensitivity and currently low specificity tools. The liver, a solid organ, could provide a more reliable site for splanchnic oxygenation and perfusion monitoring. AIMS Compare liver and lower abdomen rSO2 values in stable preterm infants in response to feeding. STUDY DESIGN We prospectively evaluated the correlation between rSO2 over the liver and lower abdomen in 16 preterm infants born between 28 and 32 weeks' gestational age using 48 h of continuous NIRS data. OUTCOME MEASURES Mean liver and lower abdomen rSO2 values. RESULTS The overall mean liver rSO2 were higher than the overall mean lower abdomen values, 78.4 ± 7.1 vs. 65.1 ± 24.9 respectively. Time series analysis showed a mean maximum cross correlation between the liver and lower abdomen of 0.28 (SD ± 0.03; p < 0.001); the liver signal lagged the lower abdomen by an average of 5.4 s (SD ± 1.2 s, Range 0-16 s). Mixed models analysis showed that during bolus feeding, liver values increased 10 to 30 min after the start of feeding (p < 0.01) while lower abdomen increased from 20 to 60 min after the start of feeding (p < 0.05) and liver values were less variable than lower abdomen values. CONCLUSION Liver rSO2 appears to be a more stable surrogate for splanchnic oxygenation and perfusion than lower abdomen rSO2.
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Affiliation(s)
- Nimrod Goldshtrom
- Department of Pediatrics, Columbia University, 630 West 168th Street, New York, NY, 10032, USA.
| | - Joseph R Isler
- Department of Pediatrics, Columbia University, 630 West 168th Street, New York, NY, 10032, USA.
| | - Rakesh Sahni
- Department of Pediatrics, Columbia University, 630 West 168th Street, New York, NY, 10032, USA.
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Low Splanchnic Oxygenation and Risk for Necrotizing Enterocolitis in Extremely Preterm Newborns. J Pediatr Gastroenterol Nutr 2020; 71:401-406. [PMID: 32404748 DOI: 10.1097/mpg.0000000000002761] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The aim of the study was to investigate whether splanchnic oxygenation (SrSO2), measured with near-infrared spectroscopy (NIRS), during the first week of life is associated with the risk of developing necrotizing enterocolitis (NEC) in extremely preterm infants. METHODS This was a prospective observational cohort study including extremely preterm infants (<28 weeks of gestation) born at Karolinska University Hospital from September 2014 to December 2016. Using 1-hour NIRS monitoring during enteral feeding, mainly continuous enteral feeding, in the first week of life we measured both cerebral and splanchnic oxygenation. Primary outcome was risk of developing NEC (Bell stage ≥ II). Secondary outcome was the association between low mean SrSO2 during the first week of life and postnatal age at full enteral nutrition. RESULTS We enrolled 52 extremely preterm newborns, but only 45 infants had complete NIRS data. One infant developed NEC within 1 day of NIRS monitoring and was excluded from the study. Median gestational age was 25.6 weeks (range 23.0-27.9) and median birth weight 698 g (range 485-1353). Eight infants developed NEC at the median postnatal age of 15 days (range 6-35). Median postnatal age at full enteral nutrition was 10 days (range 6-23). Infants with mean SrSO2 <30% had a higher risk for developing NEC compared with those with SrSO2 >30% (crude risk ratio 5.25; 95% CI [1.19-23.01]). Small for gestational age, gestational age, birth weight, postnatal age did not affect the results. We found no association between SrSO2 and age at full enteral nutrition. CONCLUSIONS Low mean SrSO2 (<30%) during the first week of life is associated with an increased risk for developing NEC in extremely preterm infants on mainly continuous enteral nutrition.
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11
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Abstract
Necrotizing enterocolitis (NEC) accounts for 10% of deaths in neonatal intensive care units. Several causal mechanisms are likely to lead to a final common disease phenotype. This article summarizes recent data on NEC following red blood cell (RBC) transfusion, with a focus on the most recent literature and ongoing trials. It highlights potential mechanisms from preclinical and human physiologic studies. It also discusses the role of feeding during RBC transfusion and the risk of NEC. Ongoing randomized trials will provide important data on how liberal or conservative approaches to RBC transfusion influence the risk of NEC.
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Affiliation(s)
- Allison Thomas Rose
- Division of Neonatology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, 2015 Uppergate Drive Northeast, Atlanta, GA 30322, USA. https://twitter.com/404Rose
| | - Vivek Saroha
- Division of Neonatology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, 2015 Uppergate Drive Northeast, Atlanta, GA 30322, USA. https://twitter.com/vsaroha
| | - Ravi Mangal Patel
- Division of Neonatology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, 2015 Uppergate Drive Northeast, Atlanta, GA 30322, USA.
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12
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Martini S, Spada C, Aceti A, Rucci P, Gibertoni D, Battistini B, Arcuri S, Faldella G, Corvaglia L. Red blood cell transfusions alter splanchnic oxygenation response to enteral feeding in preterm infants: an observational pilot study. Transfusion 2020; 60:1669-1675. [PMID: 32358809 DOI: 10.1111/trf.15821] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 02/17/2020] [Accepted: 03/26/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Preterm infants often require red blood cell (RBC) transfusions, which may impair splanchnic hemodynamics, thus predisposing to necrotizing enterocolitis (NEC). The aim of this study was to evaluate whether RBC transfusions alter splanchnic oxygenation patterns in response to enteral feeding in this population. MATERIALS AND METHODS Preterm neonates (gestational age < 32 weeks and/or birth weight < 1500 g) requiring RBC transfusions for anemia underwent a 12-hour Near Infrared Spectroscopy monitoring of splanchnic (SrSO2 ) and cerebral (CrSO2 ) oxygenation, including the transfusion period, one feed before and one after. Splanchnic-cerebral oxygenation ratio (SCOR) was also calculated. Patterns of CrSO2 , SrSO2 , and SCOR changes from baseline (Δ) in response to feed before and after transfusion were analyzed. RESULTS Twenty neonates were enrolled; none of them developed any gastrointestinal complication within 48 hours after transfusion. Pre-transfusion ΔSrSO2 and ΔSCOR increased significantly in response to feeding; on the contrary, a significant post-prandial decrease of ΔSrSO2 and ΔSCOR occurred after transfusion (p < 0.05). No difference in pre- and post-transfusion ΔCrSO2 patterns was observed. CONCLUSIONS In preterm infants, RBC transfusions may alter splanchnic oxygenation response to enteral feeds. Whether these changes are involved in the pathogenesis of transfusion-associated NEC has to be evaluated in further larger trials.
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Affiliation(s)
- Silvia Martini
- Neonatal Intensive Care Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Caterina Spada
- Department of Medical and Surgical Sciences for Mothers, Children and Adults, Post Graduate School of Pediatrics, University of Modena & Reggio Emilia, Modena, Italy
| | - Arianna Aceti
- Neonatal Intensive Care Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene and Biostatistics, University of Bologna, Bologna, Italy
| | - Dino Gibertoni
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene and Biostatistics, University of Bologna, Bologna, Italy
| | | | - Santo Arcuri
- Neonatal Intensive Care Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giacomo Faldella
- Neonatal Intensive Care Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Luigi Corvaglia
- Neonatal Intensive Care Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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13
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Predicting intestinal recovery after necrotizing enterocolitis in preterm infants. Pediatr Res 2020; 87:903-909. [PMID: 31649338 DOI: 10.1038/s41390-019-0634-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/02/2019] [Accepted: 10/07/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Intestinal recovery after NEC is difficult to predict in individuals. We evaluated whether several biomarkers predict intestinal recovery after NEC in preterm infants. METHODS We measured intestinal tissue oxygen saturation (rintSO2) and collected urinary intestinal-fatty acid binding protein (I-FABPu) levels 0-24 h and 24-48 h after NEC onset, and before and after the first re-feed. We assessed intestinal recovery in two ways: time to full enteral feeding (FEFt; below or equal/above group's median) and development of post-NEC complications (recurrent NEC/post-NEC stricture). We determined whether the rintSO2, its range, and I-FABPu differed between groups. RESULTS We included 27 preterm infants who survived NEC (Bell's stage ≥ 2). Median FEFt was 14 [IQR: 12-23] days. Biomarkers only predicted intestinal recovery after the first re-feed. Mean rintSO2 ≥ 53% combined with mean rintSO2range ≥ 50% predicted FEFt < 14 days with OR 16.7 (CI: 2.3-122.2). The rintSO2range was smaller (33% vs. 51%, p < 0.01) and I-FABPu was higher (92.4 vs. 25.5 ng/mL, p = 0.03) in case of post-NEC stricture, but not different in case of recurrent NEC, compared with infants without complications. CONCLUSION The rintSO2, its range, and I-FABPu after the first re-feed after NEC predicted intestinal recovery. These biomarkers have potential value in individualizing feeding regimens after NEC.
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14
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Seager E, Longley C, Aladangady N, Banerjee J. Measurement of gut oxygenation in the neonatal population using near-infrared spectroscopy: a clinical tool? Arch Dis Child Fetal Neonatal Ed 2020; 105:76-86. [PMID: 31154420 DOI: 10.1136/archdischild-2018-316750] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 11/04/2022]
Abstract
CONTEXT Near-infrared spectroscopy (NIRS) is a non-invasive bedside monitor of tissue oxygenation that may be a useful clinical tool in monitoring of gut oxygenation in newborn infants. OBJECTIVE To systematically review literature to determine whether NIRS is a reliable tool to monitor gut oxygenation on neonatal units. DATA SOURCES PubMed and Embase databases were searched using the terms 'neonate', 'preterm infants', 'NIRS' and 'gut oxygenation' (2001-2018). STUDY SELECTION Studies were included if they met inclusion criteria (clinical trial, observational studies, neonatal population, articles in English and reviewing regional gut oxygen saturations) and exclusion criteria (not evaluating abdominal NIRS or regional oxygen saturations). DATA EXTRACTION Two authors independently searched PubMed and Embase using the predefined terms, appraised study quality and extracted from 30 studies the study design and outcome data. LIMITATIONS Potential for publication bias, majority of studies were prospective cohort studies and small sample sizes. RESULTS Thirty studies were reviewed assessing the validity of abdominal NIRS and potential application in neonates. Studies reviewed assessed abdominal NIRS in different settings including normal neonates, bolus and continuous feeding, during feed intolerance, necrotising enterocolitis and transfusion with packed red cells. Several observational studies demonstrated how NIRS could be used in clinical practice. CONCLUSIONS NIRS may prove to be a useful bedside tool on the neonatal unit, working alongside current clinical tools in the monitoring of newborn infants (preterm and term) and inform clinical management. We recommend further studies including randomised controlled trials looking at specific measurements and cut-offs for abdominal NIRS for use in further clinical practice.
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Affiliation(s)
- Emilie Seager
- Paediatrics and Neonatal, Imperial College Healthcare NHS Trust, London, UK
| | - Catherine Longley
- Paediatrics and Neonatal, Imperial College Healthcare NHS Trust, London, UK
| | | | - Jayanta Banerjee
- Neonatology, Imperial College Healthcare NHS Trust, London, UK.,Imperial College London Institute of Clinical Sciences, London, UK
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15
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Pavlek LR, Mueller C, Jebbia MR, Kielt MJ, Fathi O. Near-Infrared Spectroscopy in Extremely Preterm Infants. Front Pediatr 2020; 8:624113. [PMID: 33553078 PMCID: PMC7859523 DOI: 10.3389/fped.2020.624113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/23/2020] [Indexed: 01/18/2023] Open
Abstract
With advances in neonatal care, survival of premature infants at the limits of viability has improved significantly. Despite these improvement in mortality, infants born at 22-24 weeks gestation are at a very high risk for short- and long-term morbidities associated with prematurity. Many of these diseases have been attributed to abnormalities of tissue oxygenation and perfusion. Near-infrared spectroscopy utilizes the unique absorption properties of oxyhemoglobin and deoxyhemoglobin to provide an assessment of regional tissue oxygen saturation, which can be used to calculate the fractional tissue oxygen extraction. This allows for a non-invasive way to monitor tissue oxygen consumption and enables targeted hemodynamic management. This mini-review provides a brief and complete overview of the background and physiology of near-infrared spectroscopy, practical use in extremely preterm infants, and potential applications in the neonatal intensive care unit. In this mini-review, we aim to summarize the three primary application sites for near-infrared spectroscopy, disease-specific indications, and available literature regarding use in extremely preterm infants.
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Affiliation(s)
- Leeann R Pavlek
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Clifford Mueller
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Maria R Jebbia
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Matthew J Kielt
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Omid Fathi
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States
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16
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Martini S, Aceti A, Galletti S, Beghetti I, Faldella G, Corvaglia L. To Feed or Not to Feed: A Critical Overview of Enteral Feeding Management and Gastrointestinal Complications in Preterm Neonates with a Patent Ductus Arteriosus. Nutrients 2019; 12:nu12010083. [PMID: 31892190 PMCID: PMC7019993 DOI: 10.3390/nu12010083] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/19/2019] [Accepted: 12/24/2019] [Indexed: 12/20/2022] Open
Abstract
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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17
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Kuik SJ, van Zoonen AGJF, Bos AF, Van Braeckel KNJA, Hulscher JBF, Kooi EMW. The effect of enteral bolus feeding on regional intestinal oxygen saturation in preterm infants is age-dependent: a longitudinal observational study. BMC Pediatr 2019; 19:404. [PMID: 31684920 PMCID: PMC6827212 DOI: 10.1186/s12887-019-1805-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/28/2019] [Indexed: 11/23/2022] Open
Abstract
Background The factors that determine the effect of enteral feeding on intestinal perfusion after preterm birth remain largely unknown. We aimed to determine the effect of enteral feeding on intestinal oxygen saturation (rintSO2) in preterm infants and evaluated whether this effect depended on postnatal age (PNA), postmenstrual age (PMA), and/or feeding volumes. We also evaluated whether changes in postprandial rintSO2 affected cerebral oxygen saturation (rcSO2). Methods In a longitudinal observational pilot study using near-infrared spectroscopy we measured rintSO2 and rcSO2 continuously for two hours on postnatal Days 2 to 5, 8, 15, 22, 29, and 36. We compared preprandial with postprandial values over time using multi-level analyses. To assess the effect of PNA, PMA, and feeding volumes, we performed Wilcoxon signed-rank tests or logistic regression analyses. To evaluate the effect on rcSO2, we also used logistic regression analyses. Results We included 29 infants: median (range) gestational age 28.1 weeks (25.1–30.7) and birth weight 1025 g (580–1495). On Day 5, rintSO2 values decreased postprandially: mean (SE) 44% (10) versus 35% (7), P = .01. On Day 29, rintSO2 values increased: 44% (11) versus 54% (7), P = .01. Infants with a PMA ≥ 32 weeks showed a rintSO2 increase after feeding (37% versus 51%, P = .04) whereas infants with a PMA < 32 weeks did not. Feeding volumes were associated with an increased postprandial rintSO2 (per 10 mL/kg: OR 1.63, 95% CI, 1.02–2.59). We did not find an effect on rcSO2 when rintSO2 increased postprandially. Conclusions Our study suggests that postprandial rintSO2 increases in preterm infants only from the fifth week after birth, particularly at PMA ≥ 32 weeks when greater volumes of enteral feeding are tolerated. We speculate that at young gestational and postmenstrual ages preterm infants are still unable to increase intestinal oxygen saturation after feeding, which might be essential to meet metabolic demands. Trial registration For this prospective longitudinal pilot study we derived patients from a larger observational cohort study: CALIFORNIA-Trial, Dutch Trial Registry NTR4153.
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Affiliation(s)
- Sara J Kuik
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, the Netherlands.
| | - Anne G J F van Zoonen
- University of Groningen, University Medical Center Groningen, Department of Surgery, Division of Pediatric Surgery, Groningen, the Netherlands
| | - Arend F Bos
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, the Netherlands
| | - Koenraad N J A Van Braeckel
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, the Netherlands
| | - Jan B F Hulscher
- University of Groningen, University Medical Center Groningen, Department of Surgery, Division of Pediatric Surgery, Groningen, the Netherlands
| | - Elisabeth M W Kooi
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, the Netherlands
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18
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Martini S, Corvaglia L, Aceti A, Vitali F, Faldella G, Galletti S. Effect of Patent Ductus Arteriosus on Splanchnic Oxygenation at Enteral Feeding Introduction in Very Preterm Infants. J Pediatr Gastroenterol Nutr 2019; 69:493-497. [PMID: 31211764 DOI: 10.1097/mpg.0000000000002420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Because of its possible effect on mesenteric blood flow, the presence of a hemodynamically significant patent ductus arteriosus (PDA) is often of concern for the introduction of enteral feeds in preterm neonates. Near-infrared spectroscopy allows a continuous monitoring of splanchnic oxygenation (SrSO2) and may provide useful hemodynamic information. This observational study evaluated SrSO2 patterns in response to first feed administration in 50 preterm infants <32 weeks' gestation with different ductal status. According to their echocardiographic characteristics, the enrolled infants were divided into the following groups: pulsatile PDA with hemodynamically significant features, restrictive PDA, and no evidence of PDA. The presence of PDA, either with restrictive or hemodynamically significant characteristics, does not significantly affect SrSO2 response to enteral feeding introduction and is not associated with increased rates of gut complications. This finding may provide encouraging evidence in support of early enteral nutrition in very preterm infants with PDA.
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Affiliation(s)
- Silvia Martini
- Neonatal Intensive Care Unit, St Orsola-Malpighi University Hospital.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Luigi Corvaglia
- Neonatal Intensive Care Unit, St Orsola-Malpighi University Hospital.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Arianna Aceti
- Neonatal Intensive Care Unit, St Orsola-Malpighi University Hospital.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Francesca Vitali
- Neonatal Intensive Care Unit, St Orsola-Malpighi University Hospital
| | - Giacomo Faldella
- Neonatal Intensive Care Unit, St Orsola-Malpighi University Hospital.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Silvia Galletti
- Neonatal Intensive Care Unit, St Orsola-Malpighi University Hospital.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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19
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Regional tissue oxygenation monitoring in the neonatal intensive care unit: evidence for clinical strategies and future directions. Pediatr Res 2019; 86:296-304. [PMID: 31247635 DOI: 10.1038/s41390-019-0466-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/24/2019] [Accepted: 06/08/2019] [Indexed: 12/19/2022]
Abstract
Near-infrared spectroscopy (NIRS)-based monitoring of regional tissue oxygenation (rSO2) is becoming more commonplace in the neonatal intensive care unit (NICU). While increasing evidence supports rSO2 monitoring, actual standards for applying this noninvasive bedside technique continue to evolve. This review highlights the current strengths and pitfalls surrounding practical NIRS-based monitoring in the neonatal population. The physiologic background of rSO2 monitoring is discussed, with attention to understanding oxygen delivery/consumption mismatch and its effects on tissue oxygen extraction. The bedside utility of both cerebral and peripheral rSO2 monitoring in the NICU is then explored from two perspectives: (1) disease/event-specific "responsive" monitoring and (2) "routine," continuous monitoring. Recent evidence incorporating both monitoring approaches is summarized with emphasis on practical applicability in the NICU. Finally, a future paradigm for a broad-based NIRS monitoring strategy is presented, with attention towards improving personalization of neonatal care and ultimately enhancing long-term outcomes.
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20
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Bajaj M, Lulic-Botica M, Hanson A, Natarajan G. Feeding during transfusion and the risk of necrotizing enterocolitis in preterm infants. J Perinatol 2019; 39:540-546. [PMID: 30723281 DOI: 10.1038/s41372-019-0328-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 12/07/2018] [Accepted: 01/15/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the effect of withholding feeds during transfusion on transfusion associated acute gut injury (TRAGI). STUDY DESIGN Data were collected on 125 preterm infants before and after the practice of withholding feeds for 12-24 h during transfusion was instituted. Logistic regression was used to examine effects of withholding feeds on TRAGI rates. RESULTS A total of 19 (15%) infants developed NEC; 6/19 (32%) had TRAGI. Postnatal hydrocortisone use was associated with TRAGI (OR 8.97; 95% CI 1.17-68.46, p = 0.034). There was no difference in NEC rates (15.8 vs. 14.7%) and the proportions (22.2 vs. 40%) of TRAGI in the two time periods before and after instituting the standardized feeding regimen and practice of holding feeds during transfusion. CONCLUSION No significant decrease was noted in the rates of TRAGI after feeds were withheld during transfusion. Further studies are warranted to explore the relationship between feeds during transfusion and NEC.
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Affiliation(s)
- Monika Bajaj
- Carman and Ann Department of Pediatrics, Department of Pediatrics, Hutzel Women's Hospital, 3980 John R Rd, Detroit, MI, 48201, USA.
| | | | - Amber Hanson
- Department of Pharmacy, Wayne State University, Detroit, MI, 48201, USA
| | - Girija Natarajan
- Carman and Ann Department of Pediatrics, Department of Pediatrics, Hutzel Women's Hospital, 3980 John R Rd, Detroit, MI, 48201, USA
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21
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Splanchnic NIRS monitoring in neonatal care: rationale, current applications and future perspectives. J Perinatol 2018; 38:431-443. [PMID: 29472709 DOI: 10.1038/s41372-018-0075-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 11/22/2017] [Accepted: 11/28/2017] [Indexed: 12/29/2022]
Abstract
Near infrared spectroscopy (NIRS) provides a non-invasive, continuous monitoring of regional tissue oxygenation. NIRS assessment of neonatal splanchnic oxygenation (SrSO2) has gained increasing interest over the last decade, as local hypoxia and ischemia underlie the most feared gut complications in neonates. Current literature provides encouraging evidence in support of SrSO2 reliability in detecting mesenteric hemodynamic changes related to various physiological and pathological conditions in-term and preterm infants. Even so, while splanchnic NIRS monitoring looks promising for investigating gut physiopathology in research settings, further studies are needed to evaluate its feasibility as a routine monitoring tool in neonatal care and to investigate its potential role in clinical decision making. After a brief introduction to NIRS technical principles, this review aims to provide a complete overview of current neonatal applications for splanchnic NIRS monitoring, to discuss its possible limitations and to suggest future directions for research and clinical applications.
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22
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Feed-related Splanchnic Oxygenation in Preterm Infants With Abnormal Antenatal Doppler Developing Gut Complications. J Pediatr Gastroenterol Nutr 2018; 66:755-759. [PMID: 29112084 DOI: 10.1097/mpg.0000000000001804] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Preterm infants with antenatal absent or reversed end diastolic flow (AREDF) in umbilical arteries are at major risk for gastrointestinal (GI) complications, such as necrotizing enterocolitis, intestinal perforation and feeding intolerance. Near-infrared spectroscopy provides continuous monitoring of splanchnic oxygenation (SrSO2) and may represent a useful tool to predict GI outcomes in this high-risk population. This observational, pilot study assessed feed-related SrSO2 patterns at enteral feeding introduction and full enteral feeding (FEF) achievement in twenty AREDF infants with gestational age ≤34 weeks. Enrolled infants were divided into 2 groups according to the development versus lack of GI complications. Infants developing GI complications showed significantly lower SrSO2 and increased splanchnic oxygen extraction in response to enteral feeds at both enteral feeding introduction and FEF. The potential role of these findings in predicting GI complications in AREDF preterm infants seems promising and deserves further evaluation.
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23
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Marulli A, Kamlin COF, Dawson JA, Donath SM, Davis PG, Lorenz L. The effect of skin-to-skin care on cerebral oxygenation during nasogastric feeding of preterm infants. Acta Paediatr 2018; 107:430-435. [PMID: 29168250 DOI: 10.1111/apa.14158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/09/2017] [Accepted: 11/17/2017] [Indexed: 11/28/2022]
Abstract
AIM To describe cerebral oxygenation during gavage feeding of preterm infants during incubator and skin-to-skin care. METHODS Further analysis of data from two crossover studies comparing cerebral oxygenation, heart rate and oxygen saturation during skin-to-skin care with incubator care. Data were analysed in three epochs; 10 minutes prefeed, during-feed and 10 minutes postfeed. Measurements from infants fed during incubator care were compared with those obtained during skin-to-skin care. RESULTS In 39 infants [median (IQR) 27.8 (26.1-30.0) weeks' gestation], there was no difference in cerebral oxygenation between pre-, during- and postfeed. Heart rate increased by three beats per minute postfeed compared with during-feed. Twenty infants received two gavage feeds, one feed in the incubator and another during skin-to-skin care. There was no difference in cerebral oxygenation and heart rate; peripheral oxygen saturation decreased by 3% during feeding whilst skin-to-skin care compared with feeding in the incubator. CONCLUSION Cerebral oxygenation remained stable before, during and after gavage feeding in an incubator and during skin-to-skin care. The small decrease in oxygen saturation whilst receiving gavage feeding during skin-to-skin care is unlikely to be clinically important, providing reassurance that preterm infants maintain physiological stability during skin-to-skin care.
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Affiliation(s)
- A Marulli
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Melbourne Vic. Australia
- University of Melbourne; Melbourne Vic. Australia
| | - COF Kamlin
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Melbourne Vic. Australia
- University of Melbourne; Melbourne Vic. Australia
- Murdoch Childrens Research Institute; Melbourne Vic. Australia
| | - JA Dawson
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Melbourne Vic. Australia
- University of Melbourne; Melbourne Vic. Australia
- Murdoch Childrens Research Institute; Melbourne Vic. Australia
| | - SM Donath
- University of Melbourne; Melbourne Vic. Australia
- Murdoch Childrens Research Institute; Melbourne Vic. Australia
| | - PG Davis
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Melbourne Vic. Australia
- University of Melbourne; Melbourne Vic. Australia
- Murdoch Childrens Research Institute; Melbourne Vic. Australia
| | - L Lorenz
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Melbourne Vic. Australia
- Department of Neonatology; University Children's Hospital of Tübingen; Tübingen Germany
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Grometto A, Pizzo B, Strozzi MC, Gazzolo F, Gazzolo D. Near-infrared spectroscopy is a promising noninvasive technique for monitoring the effects of feeding regimens on the cerebral and splanchnic regions. Acta Paediatr 2018; 107:234-239. [PMID: 28960522 DOI: 10.1111/apa.14099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/29/2017] [Accepted: 09/22/2017] [Indexed: 11/24/2022]
Abstract
AIM The effects of different milk and, or, administration regimens on cerebro-splanchnic perfusion are still a matter of debate. We investigated the effects of the bolus administration of breast milk or formula on cerebro-splanchnic oximetry, function and perfusion, assessed by near-infrared spectroscopy (NIRS). METHODS This observational study of 30 infants fed with breast (n = 15) or formula (n = 15) milk, and matched for gestational age and birth weight, was carried out in the neonatal intensive care unit of the C Arrigo Children's Hospital, Alessandria, Italy, a tertiary-level referral centre, from October 2015 to December 2016. NIRS monitoring parameters, such as cerebral and splanchnic oximetry, fraction of tissue oxygen extraction and the cerebral-splanchnic ratio, were recorded before, during and after feeding. RESULTS Breast milk led to a significant increase in cerebro-splanchnic oximetry and tissue oxygen extraction (p < 0.001) during and after feeding, and the cerebro-splanchnic perfusion ratio was significantly higher (p < 0.001) in the breast than formula group. CONCLUSION Our study results suggest that breast milk was better tolerated than formula, requiring lower energy expenditure and lower cerebro-splanchnic haemodynamic redistribution. The findings could prompt investigations using NIRS as a promising noninvasive tool for cerebral and splanchnic longitudinal monitoring during neonatal feeding.
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Affiliation(s)
- Alice Grometto
- Faculty of Biology; University of Pavia; Pavia Italy
- Department of Maternal, Fetal and Neonatal Medicine; C. Arrigo Children's Hospital; Alessandria Italy
| | - Benedetta Pizzo
- Department of Maternal, Fetal and Neonatal Medicine; C. Arrigo Children's Hospital; Alessandria Italy
- Faculty of Biology; University of Oriental Piedmont; Alessandria Italy
| | - Maria Chiara Strozzi
- Department of Maternal, Fetal and Neonatal Medicine; C. Arrigo Children's Hospital; Alessandria Italy
| | - Francesca Gazzolo
- Faculty of Biology; University of Oriental Piedmont; Alessandria Italy
| | - Diego Gazzolo
- Department of Maternal, Fetal and Neonatal Medicine; C. Arrigo Children's Hospital; Alessandria Italy
- Neonatal Intensive Care Unit G. d'Annunzio University of Chieti; Chieti Italy
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25
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Maheshwari A, Patel RM, Christensen RD. Anemia, red blood cell transfusions, and necrotizing enterocolitis. Semin Pediatr Surg 2018; 27:47-51. [PMID: 29275817 PMCID: PMC5776697 DOI: 10.1053/j.sempedsurg.2017.11.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the past 15 years, multiple clinical studies have identified a temporal association between red blood cell (RBC) transfusions and necrotizing enterocolitis (NEC). With some variability, most of these studies indicate that up to one-third of all cases of NEC involving very low-birth weight infants may occur within 24-48h after receiving a RBC transfusion. There is also evidence that the risk of such transfusion-associated NEC may be higher in infants transfused with the greatest severity of anemia. In this article, we summarize the clinical evidence pertaining to these issues; specifically, the contribution of RBC transfusions, and the contribution of severity of underlying anemia, to the pathogenesis of a type of NEC potentially termed, "transfusion/anemia-associated NEC."
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Affiliation(s)
- Akhil Maheshwari
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida; Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida; Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida.
| | - Ravi M. Patel
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322
| | - Robert D. Christensen
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84132,Intermountain Healthcare Neonatology Research Program, Intermountain Healthcare, Salt Lake City, UT 84143
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26
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Jahani S, Setarehdan SK, Boas DA, Yücel MA. Motion artifact detection and correction in functional near-infrared spectroscopy: a new hybrid method based on spline interpolation method and Savitzky-Golay filtering. NEUROPHOTONICS 2018; 5:015003. [PMID: 29430471 PMCID: PMC5803523 DOI: 10.1117/1.nph.5.1.015003] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/04/2018] [Indexed: 05/06/2023]
Abstract
Motion artifact contamination in near-infrared spectroscopy (NIRS) data has become an important challenge in realizing the full potential of NIRS for real-life applications. Various motion correction algorithms have been used to alleviate the effect of motion artifacts on the estimation of the hemodynamic response function. While smoothing methods, such as wavelet filtering, are excellent in removing motion-induced sharp spikes, the baseline shifts in the signal remain after this type of filtering. Methods, such as spline interpolation, on the other hand, can properly correct baseline shifts; however, they leave residual high-frequency spikes. We propose a hybrid method that takes advantage of different correction algorithms. This method first identifies the baseline shifts and corrects them using a spline interpolation method or targeted principal component analysis. The remaining spikes, on the other hand, are corrected by smoothing methods: Savitzky-Golay (SG) filtering or robust locally weighted regression and smoothing. We have compared our new approach with the existing correction algorithms in terms of hemodynamic response function estimation using the following metrics: mean-squared error, peak-to-peak error ([Formula: see text]), Pearson's correlation ([Formula: see text]), and the area under the receiver operator characteristic curve. We found that spline-SG hybrid method provides reasonable improvements in all these metrics with a relatively short computational time. The dataset and the code used in this study are made available online for the use of all interested researchers.
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Affiliation(s)
- Sahar Jahani
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, United States
- University of Tehran, College of Engineering, School of Electrical and Computer Engineering, Control and Intelligent Processing Center of Excellence, Tehran, Iran
| | - Seyed K. Setarehdan
- University of Tehran, College of Engineering, School of Electrical and Computer Engineering, Control and Intelligent Processing Center of Excellence, Tehran, Iran
| | - David A. Boas
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, United States
- Boston University, Neurophotonics Center, Biomedical Engineering, Boston, Massachusetts, United States
| | - Meryem A. Yücel
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, United States
- Address all correspondence to: Meryem A. Yücel, E-mail:
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27
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Splanchnic Oxygenation at First Enteral Feeding in Preterm Infants: Correlation With Feeding Intolerance. J Pediatr Gastroenterol Nutr 2017; 64:550-554. [PMID: 27467111 DOI: 10.1097/mpg.0000000000001308] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Preterm infants are at risk of developing gastrointestinal complications such as feeding intolerance and necrotizing enterocolitis. Near-infrared spectroscopy (NIRS) provides continuous monitoring of abdominal oxygenation (ArSO2) and could help to predict gastrointestinal complications in preterm neonates. In this prospective observational study, ArSO2 patterns at first enteral feed were evaluated by NIRS in 61 clinically stable preterm infants. Splanchnic-cerebral oxygenation ratio, which is a marker of gut hypoxia, was also calculated. ArSO2 and splanchnic-cerebral oxygenation ratio were significantly lower both at baseline and after feeding administration in infants who later developed feeding intolerance (n = 23). NIRS could help the early prediction of gastrointestinal complications in high-risk preterm infants.
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28
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Ledo A, Aguar M, Núñez-Ramiro A, Saénz P, Vento M. Abdominal Near-Infrared Spectroscopy Detects Low Mesenteric Perfusion Early in Preterm Infants with Hemodynamic Significant Ductus Arteriosus. Neonatology 2017; 112:238-245. [PMID: 28704836 DOI: 10.1159/000475933] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/21/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The therapeutic decision to close patent ductus arteriosus in preterm infants entails great uncertainty. Near-infrared spectroscopy is a noninvasive bedside technique used to monitor mixed regional oxygen saturation. We hypothesized that near-infrared spectroscopy could identify preterm infants at risk of mesenteric hypoperfusion associated with hemodynamically significant ductus arteriosus. METHODS This is a prospective observational study including consecutively admitted preterm infants with a gestational age <32 weeks. Mesenteric regional oxygenation was blindly monitored using an INVOS 5100 device. The presence of a hemodynamically significant patent ductus arteriosus was routinely confirmed by echocardiography/Doppler. Statistical analysis including Bland-Altman plots was performed to assess near-infrared spectroscopy intraobserver repeatability. RESULTS A total of 72 preterm infants were enrolled. The daily mean regional oxygen saturation for preterm infants was determined both in mesenteric and cerebral regions and plotted against time. We identified a differential temporary baseline. Hemodynamic significant ductus arteriosus was associated with lower blood pressures and lower regional splanchnic oxygenation. There was a significant relationship between reversal diastolic flow in the descending aorta and the regional oxygen saturation, which remained significant after controlling for ductal size and nil per os. CONCLUSIONS The simultaneous monitoring of splanchnic near-infrared spectroscopy and echocardiography could identify low mesenteric perfusion in the presence of hemodynamic ductus arteriosus.
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Affiliation(s)
- Ana Ledo
- Division of Neonatology, University and Polytechnic Hospital, Valencia, Spain
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29
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Bembich S, Cont G, Bua J, Orlando C, Di Benedetto D, Demarini S. Bolus feeding has no effect on cerebral hemodynamics, irrespective of gestational age. J Matern Fetal Neonatal Med 2016; 30:1029-1031. [PMID: 27718771 DOI: 10.1080/14767058.2016.1199672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE By multichannel near-infrared spectroscopy, we studied if gestational age has any influence on preterm cerebral hemodynamics, during bolus feeding. METHODS Oxy-haemoglobin (HbO2), as cerebral blood flow estimate, and the ratio between HbO2 and total haemoglobin (HbO2/HbTot), as cerebral oxygenation estimate, were assessed in 40 stable premature infants, during a 10 min bolus feeding. RESULTS We found no effect of any of the gestational ages studied (25-34 weeks) either on cerebral blood flow or on oxygenation, during a bolus feeding procedure. CONCLUSIONS Bolus feeding appears not to affect cerebral hemodynamics of uncritically preterm infants, irrespective of gestational age.
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Affiliation(s)
- Stefano Bembich
- a Institute for Maternal and Child Health IRCCS "Burlo Garofolo" , Trieste , Italy
| | - Gabriele Cont
- a Institute for Maternal and Child Health IRCCS "Burlo Garofolo" , Trieste , Italy
| | - Jenny Bua
- a Institute for Maternal and Child Health IRCCS "Burlo Garofolo" , Trieste , Italy
| | - Chiara Orlando
- a Institute for Maternal and Child Health IRCCS "Burlo Garofolo" , Trieste , Italy
| | | | - Sergio Demarini
- a Institute for Maternal and Child Health IRCCS "Burlo Garofolo" , Trieste , Italy
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Bozzetti V, Paterlini G, De Lorenzo P, Gazzolo D, Valsecchi MG, Tagliabue PE. Impact of Continuous vs Bolus Feeding on Splanchnic Perfusion in Very Low Birth Weight Infants: A Randomized Trial. J Pediatr 2016; 176:86-92.e2. [PMID: 27339251 DOI: 10.1016/j.jpeds.2016.05.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/30/2016] [Accepted: 05/10/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To detect changes in splanchnic perfusion and oxygenation induced by 2 different feeding regimens in infants with intrauterine growth restriction (IUGR) and those without IUGR. STUDY DESIGN This was a randomized trial in 40 very low birth weight infants. When an enteral intake of 100 mL/kg/day was achieved, patients with IUGR and those without IUGR were randomized into 2 groups. Group A (n = 20) received a feed by bolus (in 10 minutes), then, after at least 3 hours, received the same amount of formula by continuous nutrition over 3 hours. Group B (n = 20) received a feed administered continuously over 3 hours, followed by a bolus administration (in 10 minutes) of the same amount of formula after at least 3 hours. On the day of randomization, intestinal and cerebral regional oximetry was measured via near-infrared spectroscopy and Doppler ultrasound (US) of the superior mesenteric artery was performed. Examinations were performed before the feed and at 30 minutes after the feed by bolus and before the feed, at 30 minutes after the start of the feed, and at 30 minutes after the end of the feed for the 3-hour continuous feed. RESULTS Superior mesenteric artery Doppler US showed significantly higher perfusion values after the bolus feeds than after the continuous feeds. Near-infrared spectroscopy values remained stable before and after feeds. Infants with IUGR and those without IUGR showed the same perfusion and oxygenation patterns. CONCLUSION According to our Doppler US results, bolus feeding is more effective than continuous feeding in increasing splanchnic perfusion. TRIAL REGISTRATION ClinicalTrials.gov: NCT01341236.
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Affiliation(s)
- Valentina Bozzetti
- Neonatal Intensive Care Unit, MBBM Foundation, San Gerardo Hospital, Monza, Italy.
| | - Giuseppe Paterlini
- Neonatal Intensive Care Unit, MBBM Foundation, San Gerardo Hospital, Monza, Italy
| | - Paola De Lorenzo
- Department of Pediatrics, Centro Ricerca Tettamanti, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy; Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Diego Gazzolo
- Department of Maternal, Fetal, and Neonatal Medicine, C. Arrigo Children's Hospital, Alessandria, Italy
| | - Maria Grazia Valsecchi
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Paolo E Tagliabue
- Neonatal Intensive Care Unit, MBBM Foundation, San Gerardo Hospital, Monza, Italy
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31
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Akotia DH, Durham JT, Arnell KM, Petruzzelli DL, Katheria AC. Relationship Between Near-Infrared Spectroscopy and Transabdominal Ultrasonography: Noninvasive Monitoring of Intestinal Function in Neonates. Med Sci Monit 2016; 22:61-8. [PMID: 26736134 PMCID: PMC4708098 DOI: 10.12659/msm.895730] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Near-infrared spectroscopy (NIRS) has the potential to continuously and noninvasively monitor intestinal function. This technology may be valuable because among neonates, intestinal maturity is highly variable and difficult to assess based solely on clinical signs. The aim of this study was to determine if there is an association between NIRS-based StO2 measurements and peristaltic activity assessed by transabdominal ultrasonography (US). MATERIAL/METHODS Nineteen neonates of gestational age >32 weeks were categorized according to "no/low" versus "normal/hyperactive" motility levels, based on blinded US scan results. StO2 was recorded every 2 s for 24 h, following the ultrasound recording. Differences between the resulting estimates of average StO2 (bias of fits) and goodness-of-fit (residuals) were evaluated. RESULTS Newborns with normal/hyperactive motility had higher mean StO2 than newborns with no/low motility (72.3±4.4 vs. 65.5±7.9, p<0.05, F=5.65). Residual errors were not significantly different between the 2 groups (p=0.213, F=0.213). A multivariate linear regression model using the means, residuals, and pairwise products of both, demonstrated more significant separation (0.47±0.26 vs. -0.24±0.33, p<0.01, F=27.4). A non-linear variant of the multivariate linear regression model demonstrated greatest separation (0.68±0.24 vs. -0.49±0.53, p<0.01, F=41.9). CONCLUSIONS This is the first study to demonstrate an association between NIRS-based StO2 measurements and peristaltic activity visualized by ultrasound imaging. NIRS may offer a continuous, noninvasive method to assess motility. This may have significant implications in premature infants at risk for feeding intolerance or necrotizing enterocolitis.
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Affiliation(s)
- Devang H Akotia
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
| | - Jayson T Durham
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
| | - Kathy M Arnell
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
| | - Deborah L Petruzzelli
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
| | - Anup C Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
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