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Cerebrovascular response in small preterm infants during routine nursery gavage feedings
Mariana C Baserga1, George A Gregory, Augusto Sola
1Department of Pediatrics and Anesthesia, University of California-San Francisco, San Francisco, CA, USA.
Insights
Gavage feeding in premature infants can alter cerebral blood flow and oxygenation. Near-infrared spectroscopy revealed significant hemodynamic changes during tube insertion and feeding, impacting cerebral circulation.
Area of Science:
- Neonatal Physiology
- Cerebral Hemodynamics
- Medical Device Technology
Background:
- Gavage feeding is a standard care method for premature infants.
- Gavage feeding can induce hemodynamic changes affecting cerebral circulation.
- Understanding these effects is crucial for neonatal care.
Purpose of the Study:
- To investigate the impact of gavage feeding on cerebral hemodynamics and oxygenation in premature infants.
- To quantify changes in cerebral blood volume and hemoglobin levels during feeding.
- To assess the role of near-infrared spectroscopy in monitoring these changes.
Main Methods:
- Studied 23 premature infants receiving intermittent bolus gavage feeds.
- Utilized near-infrared spectroscopy (NIRS) to measure cerebral hemodynamics.
- Monitored changes in cerebral blood volume, oxygenated hemoglobin, and reduced hemoglobin.
Main Results:
- Orogastric tube insertion increased cerebral blood volume in 73% of infants.
- Feeding initiation led to decreased cerebral blood volume and oxygenation markers in ~60% of infants.
- Post-feeding, cerebral oxygenation markers improved in many infants.
Conclusions:
- Gavage feeding significantly impacts cerebral hemodynamics and oxygenation in premature infants.
- NIRS is a valuable tool for monitoring these critical physiological changes.
- Findings highlight the need for careful consideration of feeding protocols in neonates.
Abstract:
Although gavage feedings are considered a standard of care, they are often accompanied by hemodynamic changes that may have important effects on the cerebral circulation. In 23 premature infants receiving intermittent bolus gavage feeds, changes in cerebral hemodynamics and oxygenation were studied using near-infrared spectroscopy. Orogastric tube insertion resulted in an increased cerebral blood volume in 73% of the infants and in an increase in reduced hemoglobin and in cytochrome AA(3) oxygenase in approximately 66% of the patients. Within 10 min of initiating a gavage feed, cerebral blood volume, oxygenated hemoglobin, reduced hemoglobin, and cytochrome AA(3) oxygenase decreased from baseline in about 60% of the infants. Towards the end of the study, during the postfeeding period, cytochrome AA(3) oxygenase and oxygenated hemoglobin increased in 60%, while reduced hemoglobin decreased in 78% of the infants.