Abstract
Objective: Feeding intolerance (FI) is a digestive disorder that manifests itself with gastric residue, abdominal distension, and vomiting, especially in preterm infants, and often causes a prolongation of the transition to full enteral feeding. Nutrition strategy is a significant clinical challenge for neonatologists. It is tried to treat feeding intolerance with methods such as minimal enteral nutrition and slow increase in sustenance, probiotic use, prevention/treatment of NEC and sepsis, and use of specially formulated foods, but these methods are only partially effective.
Methods: Babies under 32 weeks and 1500 g hospitalized in Konya City Hospital between August 2020 and January 2022 were evaluated retrospectively. Babies with and without feeding intolerance were divided into two groups, and their demographic and clinical conditions were examined. The treatment modalities of the group with feeding intolerance were evaluated.
Results: Of the 86 patients in the study, 36 were included in the FI group, and 50 were in the healthy control group. Late neonatal sepsis and duration of parenteral nutrition were found to be statistically significantly higher in the group with feeding intolerance compared to the control group (p<0.005). In 8 of the patients, AAF/HF was used, and the transition to total enteral nutrition was achieved in a short time.
Conclusion: The diagnosis of feeding intolerance is based on non-specific clinical symptoms. When the underlying etiopathogenesis is clarified, treatment approaches may change. According to our study, it has been shown that regardless of the underlying cause of feeding intolerance, AAF/HFs can be tried as an alternative dietary option for short-term administration.
Keywords
References
- 1. Sangild PT. Gut responses to enteral nutrition in preterm infants and animals. Exp Biol Med 2006; 231(11):1695–1711.
- 2. Tudehope D, Fewtrell M, Kashyap S, Udaeta E. Nutritional needs of the micropreterm infant. J Pediatr 2013;162(Suppl. 3):72–80.
- 3. Ng D, Klassen JR, Embleton ND, McGuire W. Protein hydrolysate vs. standard formula for preterm infants. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD012412.
- 4. Fanaro S. Feeding intolerance in the preterm infant. Early Hum Dev 2013;89(Suppl 2):13–20.
- 5. Moore TA, Wilson ME. Feeding intolerance: a concept analysis. Adv Neonatal Care 2011;11:149–154.
- 6. Zhong Q, Lu Q, Peng N, Liang XH. Amino acid-based formula vs. extensively hydrolyzed formula in the treatment of feeding intolerance in preterm infants: study protocol for a randomized controlled trial. Front Nutr 2022; 9:854121.
- 7. Neu J, Zhang L. Feeding intolerance in very low birth weight infants: what is it and what can we do about it? Acta Paediatr Suppl 2005;94(449):93–99.
- 8. Cetinkaya AK, Dizdar E, Sarı FN, Tayman C, Buyuktiryaki M, Oğuz SS. Feeding intolerance associates with late onset sepsis in very low birth weight infants. J Gyn Obstet Neonatal 2021;18(1);649–652.
- 9. Lucchini R, Bizzarri B, Giampietro S, De Curtis M. Feeding intolerance in preterm infants. How to understand the warning signs. J Matern Fetal Neonatal Med 2011;24(Suppl 1):72–74.
- 10. Johston M, Landers S, Noble L, Szucs K, Viehmann L. Breastfeeding and the use of human milk. Pediatrics 2012;129(3):827–841.
- 11. Kültürsay N, Bilgen H, Türkyılmaz C. Türk Neonatoloji Derneği Prematüre ve Hasta Term Bebeğin Beslenmesi Rehberi (Güncellemesi). 2018;24–26.
- 12. Gupta BK, Bista R, Shrestha S, et al. Incidence, clinical signs and co-morbidities of feeding intolerance among preterm infants aged 28–34 weeks of gestation in a tertiary care hospital of western Nepal—a prospective observational study. J Clin Diagn Res 2021;15(8):SC01–SC05.
- 13. Neu J, Modi N, Caplan M. Necrotizing enterocolitis comes in different forms: historical perspectives and defining the disease. Semin Fetal Neonatal Med 2018;23(6):370–373.
- 14. Mihatsch WA, Franz AR, Högel J, Pohlandt F. Hydrolyzed protein accelerates feeding advancement in very low birth weight infants. Pediatrics 2002; 110:1199–1220.
- 15. Tormo R, Potau N, Infante D, Moran J, Martin B, Bergada A. A protein in infant formula: future aspects of development. Early Hum Dev 1998; 53:165–172.
- 16. Mengyuan L, Yuehui F, Yiyao L, Xiaodi L, Meijuan Q, Yuna H. Effect of hydrolyzed formulas on gastrointestinal tolerance in preterm infants: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2022;35(25):10173–10180.
- 17. Raimondi F, Spera AM, Sellitto M, Landolfo F, Capasso L. Amino acid based formula as a rescue strategy in feeding very-low-birth-weight infants with intrauterine growth restriction. J Pediatr Gastroenterol Nutr 2012;54(5):608–612.
Abstract
Amaç: Beslenme intoleransı (FI) özellikle preterm bebeklerde görülen gastrik rezidü, abdominal distansiyon ve/veya kusma ile kendini gösteren, sıklıkla tam enteral beslenmeye geçişin uzamasına neden olan sindirim bozukluğudur. Beslenme stratejisi, neonataloglar için önemli bir klinik zorluktur. Minimal enteral beslenme ve beslenmenin yavaş arttırılması, probiyotik kullanımı, NEK ve sepsisten korunma/tedavisi, özel formüllü gıdaların kullanılması gibi yöntemlerle beslenme intoleransı tedavi edilmeye çalışılmaktadır, ancak bu yöntemler tam olarak etkili değildir.
Materyal-method: Konya Şehir Hastanesinde Ağustos 2020- Ocak 2022 tarihleri arasında yatırılan 32 hf ve/veya 1500 gr altındaki bebekler retrospektif olarak değerlendirildi. Beslenme intoleransı olan ve olmayan bebekler iki gruba ayrılarak demografik ve klinik durumları incelendi. Beslenme intoleransı olan grubun tedavi şekilleri değerlendirildi.
Bulgular: Çalışmaya alınan seksen altı hastanın, 36 tanesi FI grubuna 50 tanesi sağlıklı control grubuna dahil edildi. Beslenme intoleransı olan grupta geç neonatal sepsis ve parenteral beslenme süresi kontrol grubuna göre istatistiksel olarak anlamlı derecede daha yüksek saptandı(p<0,005). Hastalardan 8 tanesinde AAF/HF kullanılarak kısa sürede tam enteral beslenmeye geçiş sağlandı.
Sonuç: Beslenme intoleransı tanısı, spesifik olmayan klinik belirtilere dayanmaktadır. Altta yatan etiyopatogenezin netleştiğinde tedavi yaklaşımları değiştirebilir. Çalışmamıza göre beslenme intoleransının altında yatan neden ne olursa olsun AAF/HF'ler alternatif bir beslenme seçeneği olarak kısa süreliğine uygulanmak üzere denenebilleceği gösterilmiştir.
Keywords
References
- 1. Sangild PT. Gut responses to enteral nutrition in preterm infants and animals. Exp Biol Med 2006; 231(11):1695–1711.
- 2. Tudehope D, Fewtrell M, Kashyap S, Udaeta E. Nutritional needs of the micropreterm infant. J Pediatr 2013;162(Suppl. 3):72–80.
- 3. Ng D, Klassen JR, Embleton ND, McGuire W. Protein hydrolysate vs. standard formula for preterm infants. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD012412.
- 4. Fanaro S. Feeding intolerance in the preterm infant. Early Hum Dev 2013;89(Suppl 2):13–20.
- 5. Moore TA, Wilson ME. Feeding intolerance: a concept analysis. Adv Neonatal Care 2011;11:149–154.
- 6. Zhong Q, Lu Q, Peng N, Liang XH. Amino acid-based formula vs. extensively hydrolyzed formula in the treatment of feeding intolerance in preterm infants: study protocol for a randomized controlled trial. Front Nutr 2022; 9:854121.
- 7. Neu J, Zhang L. Feeding intolerance in very low birth weight infants: what is it and what can we do about it? Acta Paediatr Suppl 2005;94(449):93–99.
- 8. Cetinkaya AK, Dizdar E, Sarı FN, Tayman C, Buyuktiryaki M, Oğuz SS. Feeding intolerance associates with late onset sepsis in very low birth weight infants. J Gyn Obstet Neonatal 2021;18(1);649–652.
- 9. Lucchini R, Bizzarri B, Giampietro S, De Curtis M. Feeding intolerance in preterm infants. How to understand the warning signs. J Matern Fetal Neonatal Med 2011;24(Suppl 1):72–74.
- 10. Johston M, Landers S, Noble L, Szucs K, Viehmann L. Breastfeeding and the use of human milk. Pediatrics 2012;129(3):827–841.
- 11. Kültürsay N, Bilgen H, Türkyılmaz C. Türk Neonatoloji Derneği Prematüre ve Hasta Term Bebeğin Beslenmesi Rehberi (Güncellemesi). 2018;24–26.
- 12. Gupta BK, Bista R, Shrestha S, et al. Incidence, clinical signs and co-morbidities of feeding intolerance among preterm infants aged 28–34 weeks of gestation in a tertiary care hospital of western Nepal—a prospective observational study. J Clin Diagn Res 2021;15(8):SC01–SC05.
- 13. Neu J, Modi N, Caplan M. Necrotizing enterocolitis comes in different forms: historical perspectives and defining the disease. Semin Fetal Neonatal Med 2018;23(6):370–373.
- 14. Mihatsch WA, Franz AR, Högel J, Pohlandt F. Hydrolyzed protein accelerates feeding advancement in very low birth weight infants. Pediatrics 2002; 110:1199–1220.
- 15. Tormo R, Potau N, Infante D, Moran J, Martin B, Bergada A. A protein in infant formula: future aspects of development. Early Hum Dev 1998; 53:165–172.
- 16. Mengyuan L, Yuehui F, Yiyao L, Xiaodi L, Meijuan Q, Yuna H. Effect of hydrolyzed formulas on gastrointestinal tolerance in preterm infants: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2022;35(25):10173–10180.
- 17. Raimondi F, Spera AM, Sellitto M, Landolfo F, Capasso L. Amino acid based formula as a rescue strategy in feeding very-low-birth-weight infants with intrauterine growth restriction. J Pediatr Gastroenterol Nutr 2012;54(5):608–612.
Details
| Primary Language | English |
|---|---|
| Subjects | Neonatology |
| Journal Section | Original Research |
| Authors | |
| Publication Date | September 30, 2023 |
| Acceptance Date | August 1, 2023 |
| Published in Issue | Year 2023 Volume: 13 Issue: 5 |
