Enteral Feeding of Preterms

Year 2016, Volume: 8 Issue: 2, 45 - 51, 30.03.2016

Prof. Dr. Hülya Selva Bilgen

Abstract

Abstract

Very low birth weight (VLBW) infants are at risk for postnatal growth restriction due to inadequate nutrient delivery and concomitant illness. Integrated clinical pathways or protocols can reduce the growth deficit in premature infants of VLBW. The goal while feeding VLBW infants is to reach full enteral feeding withbreast milk in the shortest time, while maintaining optimal growth and nutrition andavoiding the adverse consequences of rapid advancement of feeding. Attaining thisgoal is more difficult than it sounds, that reason close follow-up and optimal sup-port when needed is very important, especially for VLBW infants.

Keywords

preterm, enteral feeding

Prematürenin Enteral Beslenmesi

Abstract

Öz

Çok düşük doğum ağırlıklı (ÇDDA) bebekler yetersiz besin alımı ve araya giren hastalıklar nedeniyle postnatal büyüme kısıtlılığı yönünden risk altındadırlar. ÇDDA bebeklerin uygun protokoller ile izlemi bu sorunu azaltabilir. ÇDDA bebekleri izlerken hedef optimal büyümeyi sağlamak için tam enteral beslenmeye en kısa sürede anne sütü ile geçmek olmalı, ancak bebeği olumsuz etkileyecek hızlı artırımlar-dan kaçınılmalıdır.  Bu hedefi yakalamak herzaman kolay olmamaktadır; bu süreçte özellikle ÇDDA bebeklerin beslenmelerinin yakın izlemi ve gerektiğinde optimal desteğin sağlanması hedefe ulaşılmasında büyük önem taşır.

Keywords

preterm, enteral beslenme

References

• Kaynaklar 1.Ramel SE, Georgieff MK. Nutrition In: McDonald M, SeshiaMK, eds. Avery’s Neonatology: pathophysiology and mana-gement of the newborn. 7th edition, Philadelphia: Wolters Klu-ver; 2016. p280-99. 2.Morgan C, McGowan P, Herwitker S, Hart AE, Turner MA.Postnatal Head Growth in Preterm Infants: A RandomizedControlled Parenteral Nutrition Study. Pediatrics 2014;133:e120–e128 3.Dutta S, Singh B, Chessell L, Wilson J, Marianne Janes, Kim-berley McDonald, Shaneela Shahid, Victoria A. Gardner, AuneHjartarson, Margaret Purcha, Jennifer Watson, Chris de Boer,Barbara Gaal and Christoph Fusch. Guidelines for FeedingVery Low Birth Weight Infants. Nutrients 2015, 7, 423-442. 4.Fallon EM, Nehra D, Potemkin AK, Gura KM, Simpser E,Compher C. A.S.P.E.N. Clinical Guidelines: Nutrition Sup-port of Neonatal Patients at Risk for Necrotizing Enteroco-litis. J Parenter Enteral Nutr. 2012;36:506-23. 5.Marinelli KA. Breastfeeding and the use of human milk in theneonatal intensive care unit. In: McDonald M, Seshia MK, eds.Avery’s Neonatology: pathophysiology and management of thenewborn. 7th edition, Philadelphia: Wolters Kluver; 2016. p.299-335. 6.Ehrenkranz RA, Younes N, Lemons JA, Fanaroff AA, DonovanEF, Wright LL, et al. Longitudinal growth of hospitalized verylow birth weight infants. Pediatrics. 1999; 104(2):280-9. 7.Hay W. Strategies for Feeding the Preterm Infant Neonato-logy. 2008; 94(4): 245–54. 8.Morgan J, Young L, McGuire W. Delayed introduction of prog-ressive enteral feeds to prevent necrotising enterocolitis in verylow birth weight infants. Cochrane Database Syst Rev.2014;12:CD001970. 9.American Academy of Pediatrics Policy Statement. Breastfee-ding and the use of human milk. Pediatrics 2005;115: 496-506.Ballard O, Morrow AL. Human milk composition, nutrients andbioactive factors. Pediatr Clin N Am 2013; 60: 49-74. 10.Spatz DL.Ten steps for promoting and protecting breastfee-ding for vulnerable infants.J Perinat Neonatal Nurs. 2004 Oct-Dec; 18(4):385-96. 11.Lee J, Kim HS, Jung YH, Choi KY, Shin SH, Kim EK, ChoiJH. Oropharyngeal colostrum administration in extremely pre-mature infants: a RCT. Pediatrics. 2015;135(2):e357-66). 12.MCN for Neonatology West of Scotland Neonatal Guideline:Enteral Feeding of Preterm Infants – Full guideline WoS_En-teralFeedingSummary_Neonates 01/06/2013TND 13.Kültürsay N, Bilgen H, Türkyılmaz C. Preterm ve Hasta TermBebeğin Beslenmesi Rehberi, Tanı ve Tedavi Protokolleri, 2015. 14.Loomis T, Byham-Gray L, Ziegler J, Parrott JS. Impact of stan-dardized feeding guidelines on enteral nutrition administrati-on, growth outcomes, metabolic bone disease, and cholestasisin the NICU. J Pediatr Gastroenterol Nutr. 2014;59(1):93-8. 15.Morgan J, Young L, McGuire W. Slow advancement of ente-ral feed volumes to prevent necrotising enterocolitis in verylow birth weight infants. Cochrane Database Syst Rev.2015;15;10:CD001241. 16.Watson J, McGuire W. Nasal versus oral route for placing fee-ding tubes in preterm or low birth weight infants. CochraneDatabase Syst Rev. 2013; 28;2:CD003952. doi:10.1002/14651858.CD003952. 17.Aynsley-Green A, Adrian TE, Bloom SR. Feeding and the de-velopment of enteroinsular hormone secretion in the preterminfant: effects of continuous gastric infusions of human milkcompared with intermittent boluses. Acta Paediatr Scand 1982;71: 379-83. 18.Premji SS, Chessell L. Continuous nasogastric milk feedingversus intermittent bolus milk feeding for premature infants-less than 1500 grams. Cochrane Database Syst Rev. 20119;(11):CD001819. 19.Neu J, Zhang L. Feeding intolerance in very-low-birthweightinfants: what is it and what can we do about it? Acta Paedi-atr Suppl 2005;94:93–9. 20.Li YF, Lin H, Torrazza RM, Parker L, Talaga E, Neu J. Gas-tric Residual Evaluation in Preterm Neonates: A Useful Monitoring Technique or a Hindrance? Pediatr Neonatol. 201455(5):335-40. 21.Bertino E, Giuliani F, Prandi G, Coscia A, Martano C, Fab-ris C. Necrotising enterocolitis: risk factor analysis and role ofgastric residuals in very low birth weight infants. Journal of Pe-diatric Gastroenterology and Nutrition 2009; 48(4):437-42. 22.Fanaro S. Feeding intolerance in the preterm infant. Early HumDev. 2013;89 Suppl 2:S13-20. 23.Mihatsch WA,von Schoenaich P, Fahnenstich H, Dehne N, Eb-becke H, Plath C et al. The significance of gastric residualsin the early enteral feeding advancement of extremely low birthweight infants. Pediatrics 2002, 109, 457–9. 24.Lucas RF, Smith RL. When is it safe to initiate breastfeedingfor preterm infants? Adv Neonatal Care. 2015;15(2):134-41. 25.Furman L, Taylor G, Minich N, Hack M. The effect of mater-nal milk on neonatal morbidity of very low-birth-weight in-fants. Arch Pediatr Adolesc Med. 2003; 157(1):66-71. 26.Ballard O, Morrow AL. Human milk composition, nutrientsand bioactive factors. Pediatr Clin N Am. 2013; 60: 49-74. 27.Kashyap S, Schulze KF, Forsyth M, Dell RB, RamakrishnanR, Heird WC. Growth, nutrient retention, and metabolic res-ponse of low-birth-weight infants fed supplemented and un-supplemented preterm human milk. Am J Clin Nutr. 1990;52(2):254-62. 28.Sullivan S, Schanler RJ, Kim JH, Patel AL, Trawoger R, Ki-echl-Kohlendorfer U, et al. An exclusively human milk-baseddiet is associated with a lower rate of necrotizing enteroco-litis than a diet of human milk and bovine milk-based products.J Pediatr. 2010;156(4):562–7. 29.Lau C, Hurst NM, Smith EO, Schanler RJ. Ethnic/racial di-versity, maternal stress, lactation and very low birthweight in-fants. J Perinatol. 2007; 27(7):399–408. 30.Lucas A, Fewtrell M, Morley R, Lucas P, Baker B, Lister G,et al. Randomized outcome trial of human milk fortificationand developmental outcome in preterm infants. Am J Clin Nutr1996;64(2):142-51. 31.the Halleux V, Rigo J. Variability in human milk compositi-on: benefit of individualized fortification in very-low-birthwe-ight infants. Am J Clin Nut. 2013; 98(2):529-35. 32.Polberger S, Räihä NC, Juvonen P, Moro GE, Minoli I, WarmA. Individualized protein fortification of human milk for pre-term infants: comparison of ultrafiltrated human milk prote-in and a bovine whey fortifier. J Pediatr Gastroenterol Nutr.1999 Sep; 29(3):332-8. 33.Arslanoglu S, Moro GE, Ziegler EE. Adjustable fortificationof human milk fed to preterm infants: does it make a differen-ce? J Perinatol. 2006 ;26(10):614–21). 34.Arslanoglu S, Bertino E, Coscia A, Tonetto P, Giuliani F, MoroGE. Update of adjustable fortification regimen for preterm in-fants: a new protocol. J Biol Regul Homeost Agents. 2012;26(3Suppl):65-7. 35.Tian X, Yi LJ, Zhang L, Zhou JG, Ma L, Ou YX, Shuai T, ZengZ, Song GM. Oral Motor Intervention Improved the Oral Fee-ding in Preterm Infants: Evidence Based on a Meta-AnalysisWith Trial Sequential Analysis. Medicine (Baltimore).2015;94(31):e1310. 36.Nygivst, KH. 2008; Early attainment of breastfeeding compe-tence in very preterm infants. Acta Paediatricia, 97(6), 776-81. 37.Flint A, New K, Davies MW. Cup feeding versus other formsof supplemental enteral feeding for newborn infants unableto fully breastfeed. Cochrane Database Syst Rev. 2007 Apr18;(2):CD005092. 38.Pineda R. Direct breast-feeding in the neonatal intensive careunit: is it important? J Perinatol. 2011;31(8):540-5. 39.Ryan AS, Wenjum Z, Acosta A. Breastfeeding continues to in-crease into the new millennium. Pediatrics 2002; 110:1103-9. 40.Underwood MA. Human milk for the premature infant. Pedi-atr Clin North Am. 2013;60(1):189-207. 41.Maastrup R, Hansen BM, Kronborg H, Bojesen SN, HallumK, et al. Breastfeeding Progression in Preterm Infants Is In-fluenced by Factors in Infants, Mothers and Clinical Prac-tice: The Results of a National Cohort Study with High Bre-astfeeding Initiation Rates. PLoS ONE. 2014; 9(9): e108208. 42.Parker M, Burnham L, Cook J, Sanchez E, Philipp BL, Me-rewood A. 10 years after baby-friendly designation: breast-feeding rates continue to increase in a US neonatal intensi-ve care unit. J Hum Lact. 2013; 29(3):354-8.