Neonatal Medicine

The Korean Society of Neonatology (대한신생아학회)
권호 표지

Enteral Feeding for Preterm Infants-Benefits and Risks

미숙아의 장관영양

  • Sin, Jong-Beom (Department of Pediatrics, College of Medicine, Inje University)
  • 신종범 (인제대학교 의과대학 소아과학교실)
  • Published : 2009.11.30

⟨ Previous Next ⟩

Abstract

Over the past 20 years, neonatal mortality rates for preterm infants, particularly those born extremely preterm and with a very low birth weight, have decreased steadily. As more very immature preterm infants survive, provision of enteral feeding has become a major focus of concern. According to many experts on neonatal nutrition, the goal for the nutrition of preterm infants should be to achieve a postnatal growth rate approximating that of a normal fetus of the same gestational age. Total parenteral nutrition for maintaining nutritional integrity is mandatory before successful transition to enteral feeding. Early initiation of trophic enteral feeding is vital for postnatal adaptation. Recently published randomized controlled trials provide no evidence to support the practice of postponing enteral feeding to reduce the incidence of necrotizing enterocolitis. Early trophic feeding yields demonstrable benefits and there is currently no evidence of any adverse effects following early feeding. Preterm milk from the infant's own mother is the milk of choice, which can always be supplemented with a human milk fortifier. Here we review over 50 randomized controlled trials and over seven systematic reviews published on neonatal parenteral and enteral feeding of preterm infants. Neonatologists must make use of the evidence from these studies as a reference for feeding protocols for preterm infants in their NICUs are to be based.

Keywords

References

  1. Hay WW Jr. Strategies for feeding the preterm infant. Neonatology 2008;94:245-54. https://doi.org/10.1159/000151643
  2. Berseth CL, Nordyke C. Enteral nutrients promote postnatal maturation of intestinal motor activity in preterm infants. Am J Physiol 1993;264:G1046-51.
  3. Caicedo RA, Schanler RJ, Li N, Neu J. The developing intestinal ecosystem: implications for the neonate. Pediatr Res 2005;58:625-8. https://doi.org/10.1203/01.PDR.0000180533.09295.84
  4. Greer FR. Feeding the premature infant in the 20th century. J Nutr 2001;131:426s-30s.
  5. Gordon HH, Levine SZ, McNamara H. Feeding of premature infants. A comparison of human and cow's milk. Am J Dis Child 1947;73:442-52.
  6. Heird WC, Driscol JM Jr. Historic perspective: Total parenteral nutrition. Neoreviews 2003:4:e137-9 https://doi.org/10.1542/neo.4-6-e137
  7. Davies DP. The first feed of low birth weight infants. Changing attitudes in the twentieth century. Arch Dis Child 1978;53:187-92. https://doi.org/10.1136/adc.53.3.187
  8. Raiha NC, Heinonen K, Rassin DK, Gaul GE. Milk protein quantity and quality in low-birthweight infants: I. Metabolic responses and effects on growth. Pediatrics 1976;57:656-84.
  9. Lucas A, Bloom S, Aynsley-Green A. Gut hormones and 'Minimal Enteral Feeding'. Acta Paediatr Scand 1986;75:719-23. https://doi.org/10.1111/j.1651-2227.1986.tb10280.x
  10. Lau C. Oral feeding in the preterm infant. Neoreviews 2006;7:e19-27. https://doi.org/10.1542/neo.7-1-e19
  11. Yu VY. Enteral feeding in the preterm infant. Early Hum Dev 1999;56:89-115. https://doi.org/10.1016/S0378-3782(99)00047-X
  12. Dunn L, Hulmann S,Weiner J, Kliegman R. Beneficial effects of early hypocaloric enteral feeding on neonatal gastrointestinal function: preliminary report of a randomized trial. J Pediatr 1988;112:622-9. https://doi.org/10.1016/S0022-3476(88)80185-9
  13. Johnson CR. The trophic action of gastrointestinal hormones. Gastroenterology 1976;70:277-8.
  14. Berseth CL. Effect of early feeding on maturation of the preterm infants' small intestine. J Pediatr 1992;120:947-53. https://doi.org/10.1016/S0022-3476(05)81969-9
  15. Berseth CL. Minimal enteral feedings. Clin Perinatol 1995;22:195-205.
  16. Tyson JE, Kennedy KA. Trophic feeding for parenterally fed infants. In: The Cochrane Database Syst Rev 2005;20:3:CD000504.
  17. McClure RJ,Newell SJ. Randomized controlled study of clinical outcome following trophic feeding. Arch Dis Child Fetal Neonatal Ed 2008;82:F29-33
  18. McKeown RE, Marsh TD, Amarnath U, Garrison CZ, Addy CL, Thompson SJ, et al. Role of delayed feeding and of feeding increments in necrotizing enterocolitis. J Pediatr 1992;121:764-70. https://doi.org/10.1016/S0022-3476(05)81913-4
  19. Kennedy KA, Tyson JE, Chamnanvanakij S. Rapid versus slow rate of advancement of feedings for promoting growth and preventing necrotizing enteerocolitis in parenterally fed low-birth-weight infants. Cochrane Database Syst Rev 2009;2:CD001241.
  20. Hsueh W, Caplan MS, Qu XW, Tan XD, De Plaen IG, Gonzalez-Crussi F. Neonatal necrotizing enterocolitis: clinical considerations and pathogenetic concepts. Pediatr Dev Pathol 2003;6:6-23. https://doi.org/10.1007/s10024-002-0602-z
  21. Moody GJ, Schanler RJ, Lau C, Shulman RJ. Feeding tolerance in premature infants fed fortified human milk. J Pediatr Gastroenterol Nutr 2000;30:408-12. https://doi.org/10.1097/00005176-200004000-00011
  22. Lander A, Desai A. The risks and benefits of cisapride in premature neonates, infants, and children. Arch Dis Child. 1998;79:469-70. https://doi.org/10.1136/adc.79.6.469
  23. Costalos C, Gounaris A, Varhalama E, Kokori F, Alexiou N, Kolovou E. Erythromycin as a prokinetic agent in preterm infants. J Pediatr Castroenterol Nutr 2002;34:23-5. https://doi.org/10.1097/00005176-200201000-00006
  24. Ng PC, So KW, Fung KS, Lee CH, Fok TF, Wong E, et al. Randomised controlled trial of oral erythromycin for treatment of gastrointestinal dysrnotility in preterm infants. Arch Dis Child Fetal Neonatal Ed 2001;84:F177-82. https://doi.org/10.1136/fn.84.3.F177
  25. Stenson BJ, Middlemist L, Lyon AJ. Influence of erythromycin on establishment of feeding in preterm infants: observations from a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 1998;79:F212-4. https://doi.org/10.1136/fn.79.3.F212
  26. Patole SK, Almonte R, Kadalraja R, Tuladhar R, Muller R, Whitehall JS. Can prophylactic oral erythromycin reduce time to full enteral feeds in preterm neonates? Int J Clin Pract 2000;54:504-8.
  27. Ng PC. Use of oral erythromycin for the treatment of gastrontestinal dysmotility in preterm infants. Neonatology 2009;95:97-104. https://doi.org/10.1159/000153093
  28. Ng E, Shah V. Erythromycin for feeding intolerance in preterm infants. The Cochrane Database of Syst Rev 2008;3:CD001815.
  29. OeiJ, Lui K. A placebo-controlled trial of low-dose erythromycin to promote feed tolerance in preterm infants. Acta Paediatr 2001;90:904-8. https://doi.org/10.1080/08035250117448
  30. ElHennawy AA, Sparks JW, Armentrout D, Huseby V, Berseth CL. Erythromycin fails to improve feeding outcome in feeding-intolerant preterm infants. J Pediatr Gastroenterol Nutr 2003;37:281-6. https://doi.org/10.1097/00005176-200309000-00015
  31. Ng SC, Gomez JM, Rajadurai VS, Saw SM, Quak SH. Establishing enteral feeding in preterm infants with feeding intolerance: a randomized controlled study of low-dose erythromycin. J Pediatr Gastroenterol Nutr 2003;37:554-8. https://doi.org/10.1097/00005176-200311000-00009
  32. Cairns P, Craig S, Tubman R, Roberts RS, Wilson J, Schmidt B. Randomised controlled trial of lowdose erythromycin in preterm infants with feed intolerance (abstract). Pediatr Res 2002;51:379A-80A.
  33. Aly H, Abdel-Hady H, Khashaba M, El-Badry N. Erythromycin and feeding intolerance in premature infants: a randomized trial.J Perinatol 2007;27:39-43. https://doi.org/10.1038/sj.jp.7211618
  34. Nuntnarumit P, Kiatchoosakun P, Tantiprapa W, Boonkasidecha S. Efficacy of oral erythromycin for treatment of feeding intolerance in preterm infants. J Pediatr 2006;148:600-5. https://doi.org/10.1016/j.jpeds.2005.12.026
  35. Ng PC, Lee CH, Wong SPS, Lam HS, Liu FYB, So KW, et al. High-dose oral erythromycin decreased the incidence of parenteral nutrition-associated cholestasis in preterm infants. Gastroenterology 2007;132:1726-39. https://doi.org/10.1053/j.gastro.2007.03.043
  36. Lucas A, Cole TJ. Breast milk and neonatal necrotising enterocolitis. Lancet 1990;336:1519-23. https://doi.org/10.1016/0140-6736(90)93304-8
  37. Furman L, Taylor G, Minich N, Hack M. The effect of maternal milk on neonatal morbidity of very low-birth-weight infants. Arch Pediatr Adolesc Med 2003;157:66-71. https://doi.org/10.1001/archpedi.157.1.66
  38. Hylander MA, Strobino DM, Dhanireddy R. Human milk feedings and infection among very low birth weight infants. Pediatrics 1998;102:e38
  39. de Silva A, Jones PW, Spencer SA. Does human milk reduce infection rates in preterm infants? A systematic review. Arch Dis Child Fetal Neonatal Ed 2004;89:F509-13. https://doi.org/10.1136/adc.2003.045682
  40. Lucas A, Morley R. Cole TJ, Lister G, Leeson-Payne C. Breast milk and subsequent intelligence quotient in children born preterm. Lancet 1992;339:261-4. https://doi.org/10.1016/0140-6736(92)91329-7
  41. Hylander MA, Strobino DM, Pezzullo JC, Dhanireddy R. Association of human milk feedings with a reduction in retinopathy of prematurity among very low birth weight infants. J Perinatol 2001;21:356-62. https://doi.org/10.1038/sj.jp.7210548
  42. Schanler RJ. The use of human milk for premature infants. Pediatr Clin North Am 2001;48:207-19. https://doi.org/10.1016/S0031-3955(05)70295-9
  43. Henderson G, Anthony MY, McGuire W. Formula milk versus preterm human milk for feeding or low birth weight infants. The Cochrane Database of Syst Rev 2009;2:CD002972.
  44. Schanler RJ, Lau C, Hurst NM, Smith EOB. Randomized trial of donor human milk versus preterm formula as substitutes for mothers' own milk in the feeding of extremely premature infants. Pediatrics 2005;116:400-6. https://doi.org/10.1542/peds.2004-1974
  45. Hay WW Jr, Lucas A, Heird WC, Ziegler E, Levin E, Grave GD, et al. Workshol summary: nutrition of the extremely low birth weight infant. Pediatrics 1999;104:1360-8. https://doi.org/10.1542/peds.104.6.1360
  46. Schanler RJ, Shulman RJ, Lau C. Feeding strategies for premature infants: beneficial outcomes of feeding fortified human milk versus preterm formula. Pediatrics 1999;103:1150-7. https://doi.org/10.1542/peds.103.6.1150
  47. Yu VY, Jamieson J, Bajuk B. Breast milk feeding in very low birth weight infants. Aust Paediatr J 1981;17:186-90.
  48. Gartner LM, Morton J, Lawrence RA, Naylor AJ, O'Hare D, Schanler RJ, et al. American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2005;115:496-506. https://doi.org/10.1542/peds.2004-2491
  49. Kuschel CA, Harding JE. Multicomponent fortified human milk for promoting growth in preterm infants. The Cochrane Database of Syst Rev 2004; 1:CD000343.
  50. Yu JE, Pai KS, JY Ham, Park MS, Yun SS. Effect of maeil human milk fortifier on growth and bone mineralization in preterm infants. J Korean Soc Neonatol 2005;12:32-41.
  51. Chueh HW, KIm MJ, Lee Y A, lung JA. Growth and clinical efficacy of fortified human milk and preter formula on very low birth weight infants. Korean J Pediatr 2008;51:704-12. https://doi.org/10.3345/kjp.2008.51.7.704