The Effect of Neonatal Feeding Modalities on Splanchnic Oxygenation
Condition: Intrauterine Growth Retardation; Feeding Patterns; Splanchnic Hypoperfusion
MeSH terms: Fetal Growth Retardation
Study type: Interventional

Summary: 
      OBJECTIVES: 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 (IUGR). The second objective was to assess the relationship between fetal
      splanchnic circulation parameters and splanchnic oxygenation during the first week of life.

      METHODS: 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-hour continuous) or
      intermittent (bolus in 10 minutes). Continuous regional splanchnic saturation (rSO2S)
      monitoring was carried out during 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.

      RESULTS: 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 two days,
      infants with umbilical catheters had significantly lower rSO2S values than infants without.

      CONCLUSIONS: Our data suggests 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.
    

Detailed description: 
      Study design This single-center prospective randomized study was conducted in a university
      hospital between 1 January 2019-1 October 2021. This work has been supported by Eskisehir
      Osmangazi University Scientific Research Projects Coordination Unit under grant number
      61690618-604.99-E.61140. This study was conducted in conformity with the principles and
      regulations of the Helsinki Declaration. The Institutional Ethics Committee approved the
      study (No: 80558721-050.99-E.105607) and informed consent forms were received from all
      parents/legal guardians of each fetus/infant before inclusion in the study.

      Study Cohort The inclusion criteria were that the parents agreed to participate in the study
      and that Doppler measurements could be performed in fetuses with IUGR and following preterm
      birth (GA<37 weeks) with no enteral nutrition prior to enrolment. The infants with
      chromosomal or major congenital abnormalities that may influence the ability to monitor the
      splanchnic bed (congenital heart defects, abdominal wall defects, or congenital diaphragmatic
      hernia), inherited metabolic diseases, hydrops fetalis, TORCH infection, multiorgan failure,
      infants with spontaneous intestinal perforation, infants with skin lesions at the site of
      sensor placement and infants who were hospitalized shorter than 7 days because of discharge
      or death were excluded from the study.
    

Intervention name(s): The effect of drip versus intermittent feeding on splanchnic oxygenation
Intervention type(s): Other
Intervention description(s): After preterm delivery the infants were randomly assigned to one of two feeding modalities: drip (3-hour continuous) or intermittent (bolus in 10 minutes).
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A single-center, prospective, randomized trial
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: fetal superior mesenteric artery; Intrauterine Growth Retardation; drip feeding; intermittent feeding; regional splanchnic saturation; umbilical catheter