Enteral feeding during indomethacin treatment for patent ductus arteriosus: association with gastrointestinal outcomes

• Published in: Journal of perinatology 2016-07, Vol.36 (7), p.544-548
• Main Authors: Louis, D, Torgalkar, R, Shah, J, Shah, P S, Jain, A
• Format: Article
• Language: English
• Subjects: 692/420/256/2516; 692/699/1503/1581/1392/1388; Birth Weight; Breastfeeding & lactation; Canada; Care and treatment; Cohort analysis; Complications; Complications and side effects; Congenital diseases; Coronary vessels; Digestive symptoms; Dosage and administration; Drug dosages; Ductus Arteriosus, Patent - complications; Ductus Arteriosus, Patent - therapy; Enteral feeding; Enteral Nutrition; Enterocolitis; Enterocolitis, Necrotizing - chemically induced; Enterocolitis, Necrotizing - epidemiology; Epidemiology; Female; Gastrointestinal diseases; Gestational Age; Health aspects; Humans; Indomethacin; Indomethacin - administration & dosage; Indomethacin - adverse effects; Infant, Extremely Premature - growth & development; Infant, Newborn; Infant, Very Low Birth Weight - growth & development; Intensive care; Intensive care units; Intensive Care Units, Neonatal; Linear Models; Logistic Models; Male; Medicine; Medicine & Public Health; Methods; Morbidity; Multivariate Analysis; Necrotizing enterocolitis; Neonates; original-article; Patent ductus arteriosus; Pediatric Surgery; Pediatrics; Physiological aspects; Preempting; Premature infants; Reduction; Retrospective Studies; Risk factors; Secondary analysis
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/jp.2016.11

OBJECTIVE: Enteral feeds are often discontinued or reduced during indomethacin treatment for patent ductus arteriosus (PDA) in preterm neonates, but the clinical impact of this practice is unknown. The objective of this study was to study the associations between enteral feed volume at the time of indomethacin therapy in preterm neonates with PDA and subsequent gastrointestinal outcomes. STUDY Design: Retrospective cohort study. Single-center level III Neonatal Intensive Care Unit. RESULTS: All consecutive preterm neonates who had received treatment with indomethacin for PDA over a 5-year period were included and categorized based on enteral feed volume exposure during treatment (Group A: nil per oral (NPO, N =229); Group B: ⩽60 ml kg −1  day −1 ( N =142); Group C:>60 ml kg −1  day −1 ( N =44)). Baseline characteristics and clinical outcomes were compared between the three groups. The primary outcome was necrotizing enterocolitis (NEC) ⩾stage IIa, while secondary outcomes included other gastrointestinal complications and common prematurity-related morbidities. Group C had a higher gestational age (mean±s.d.; A: 26.3±1.8; B: 26.1±1.8; C: 27.0±2.0 weeks), birth weight (A: 864±239; B: 847±202; C: 932±234 g) and postnatal age at the time of indomethacin treatment (A: 5.3±2.9; B: 7.2±4.9; C: 15.4±6.6 days). All groups had similar rates of the primary outcome NEC (A: 6.1%, B: 7.8% and C: 4.6%, respectively). They also had similar rates of the secondary outcomes with the exception of days to reach enteral feeds of 120 ml kg −1  day −1 (A: 22.8±8.5; B: 20.5±8.6; C: 16.8±7.7; P