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Gastrointestinal priming prior to full enteral nutrition in very low birth weight infants
W H Meetze1, C Valentine, J E McGuigan
1Department of Pediatrics, University of Florida College of Medicine, Gainesville.
Insights
Gastrointestinal (GI) priming with low-volume feedings in premature infants improves feeding tolerance and accelerates serum gastrin levels. This practice, using full-strength formula, enhances GI tract maturation without increasing feeding complication risks.
Area of Science:
- Neonatal nutrition
- Gastroenterology
- Pediatric research
Background:
- Enteral feeding practices for very premature infants are debated.
- Total parenteral nutrition (TPN) is often used for high-risk neonates.
- Gastrointestinal (GI) priming is a controversial method to prepare the gut for enteral feeding.
Purpose of the Study:
- To investigate the effects of GI priming on weight gain, feeding tolerance, nutritional status, and serum gastrin levels in premature infants.
- To determine if GI priming hastens intestinal growth and maturation.
- To assess the safety and efficacy of GI priming compared to TPN alone.
Main Methods:
- A randomized study comparing GI priming plus TPN versus TPN alone in infants weighing <1,250 g.
- Infants received feedings starting on day 3 of life, with gradual advancement to full enteral feeds.
- Serum gastrin levels and feeding tolerance were monitored throughout the study period.
Main Results:
- GI-primed infants demonstrated improved feeding tolerance after day 20.
- A faster increase in serum gastrin was observed in the GI-primed group during the initial study phase.
- No significant differences in weight gain were found between the groups.
Conclusions:
- GI priming enhances feeding tolerance and accelerates serum gastrin levels in premature infants.
- This practice may promote more rapid gastrointestinal tract maturation.
- GI priming is a safe and effective strategy when compared to TPN alone, without increased risk of feeding complications.
Abstract:
Priming of the gastrointestinal (GI) tract with low-volume feedings before giving full enteral feedings to very premature, high-risk infants is a controversial practice. We designed a study of infants weighing less than 1,250 g and receiving total parenteral nutrition to determine whether GI priming would hasten weight gain, improve tolerance of subsequent feedings, enhance nutritional status, and increase serum concentration of gastrin, a hormone trophic for intestinal growth. Infants were randomly assigned to receive total parenteral nutrition (TPN) alone (N = 21) or GI priming plus TPN (N = 19) for 12 days beginning on day 3 of life. Full-strength premature infant formula was used for priming. Both groups received the same total nutrition. Beginning on day 15, feedings in both groups were increased daily to a maximum of 120 kcal/kg/day on day 20, where they were maintained until day 30. After day 30, the feedings were modified according to the infants' condition. The groups did not differ in birth weight, gestational age, or 5-min Apgar scores. GI-primed infants had improved feeding tolerance after day 20 and a faster rise in serum gastrin during the initial phase of the study. There was no significant difference in weight gain. GI priming improves tolerance of feedings, accelerates rate of rise of serum gastrin during the first weeks of life, and does not increase the risk of feeding complications when compared to TPN alone. This may lead to more rapid maturation of the GI tract in primed infants.