Impact of Continuous vs Bolus Feeding on Splanchnic Perfusion in Very Low Birth Weight Infants: A Randomized Trial

• Published in: The Journal of pediatrics 2016-09, Vol.176, p.86-92.e2
• Main Authors: Bozzetti, Valentina, PhD, Paterlini, Giuseppe, MD, De Lorenzo, Paola, PhD, Gazzolo, Diego, MD, Valsecchi, Maria Grazia, PhD, Tagliabue, Paolo E., MD
• Format: Article
• Language: English
• Subjects: bolus nutrition; continuous nutrition; Cross-Over Studies; Enteral Nutrition - methods; Female; Fetal Growth Retardation - physiopathology; Humans; Infant; Infant, Newborn; Infant, Very Low Birth Weight; IUGR; Male; NIRS; Pediatrics; SMA Doppler; Spectroscopy, Near-Infrared; Splanchnic Circulation; splanchnic oxygenation; Ultrasonography, Doppler
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2016.05.031

Objective To detect changes in splanchnic perfusion and oxygenation induced by 2 different feeding regimens in infants with intrauterine growth restriction (IUGR) and those without IUGR. Study design This was a randomized trial in 40 very low birth weight infants. When an enteral intake of 100 mL/kg/day was achieved, patients with IUGR and those without IUGR were randomized into 2 groups. Group A (n = 20) received a feed by bolus (in 10 minutes), then, after at least 3 hours, received the same amount of formula by continuous nutrition over 3 hours. Group B (n = 20) received a feed administered continuously over 3 hours, followed by a bolus administration (in 10 minutes) of the same amount of formula after at least 3 hours. On the day of randomization, intestinal and cerebral regional oximetry was measured via near-infrared spectroscopy and Doppler ultrasound (US) of the superior mesenteric artery was performed. Examinations were performed before the feed and at 30 minutes after the feed by bolus and before the feed, at 30 minutes after the start of the feed, and at 30 minutes after the end of the feed for the 3-hour continuous feed. Results Superior mesenteric artery Doppler US showed significantly higher perfusion values after the bolus feeds than after the continuous feeds. Near-infrared spectroscopy values remained stable before and after feeds. Infants with IUGR and those without IUGR showed the same perfusion and oxygenation patterns. Conclusion According to our Doppler US results, bolus feeding is more effective than continuous feeding in increasing splanchnic perfusion. Trial registration ClinicalTrials.gov : NCT01341236.