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Effect of early feeding on maturation of the preterm infant's small intestine
1Department of Pediatrics, Mayo Clinic, Rochester, Minnesota.
Insights
Early enteral nutrition in preterm infants promotes gut maturity and improves feeding tolerance. This approach leads to earlier full oral nutrition, fewer feeding intolerance days, and shorter hospital stays, supporting its use.
Area of Science:
- Neonatology
- Gastroenterology
- Pediatric Nutrition
Background:
- Preterm infants often experience feeding difficulties and delayed gut maturation.
- The optimal timing for initiating enteral nutrition in preterm infants remains a critical clinical question.
- Gastrointestinal peptide responses are key indicators of gut development and function.
Purpose of the Study:
- To investigate the intestinal response of preterm infants to early versus late hypocaloric enteral nutrition.
- To assess the impact of feeding timing on gastrointestinal motor patterns and peptide concentrations.
- To evaluate the effect of early nutrition on feeding tolerance and hospital stay duration.
Main Methods:
- 27 preterm infants were randomized into early (days 3-5) and late (days 10-14) feeding groups.
- Gastroduodenal manometry and plasma concentrations of gastrin, GIP, neurotensin, and PYY were measured.
- Measurements were taken at three postnatal time points: days 3-5, 10-14, and 24-28.
Main Results:
- Early-fed infants demonstrated more mature motor patterns by postnatal days 10-14 compared to late-fed infants.
- Higher plasma concentrations of gastrin and gastric inhibitory peptide (GIP) were observed in early-fed infants.
- Early feeding was associated with earlier tolerance of full oral nutrition and fewer days of feeding intolerance.
Conclusions:
- Early hypocaloric enteral nutrition accelerates intestinal functional development in preterm infants.
- Initiating nutrition early improves feeding tolerance and may reduce hospital length of stay.
- Findings support the clinical practice of early enteral feeding in preterm neonates.
Abstract:
To determine the response of the preterm infant's intestine to entire feedings at different postnatal ages, we recorded results of manometry of the gastroduodenum and determined fasting plasma concentrations of gastrin, gastric inhibitory peptide, neurotensin, and peptide YY three times in each of two groups: 27 preterm infants were randomly assigned to receive hypocaloric enteral nutrition on postnatal days 3 to 5 (early feeding) or on days 10 to 14 (late feeding). Initial observations (study 1) were performed by the fifth postnatal day; study 2 was performed on days 10 to 14, and study 3 on days 24 to 28. Early-fed infants received hypocaloric feedings immediately after study 1; late-fed infants did not receive enteral feedings until the completion of study 2. Although motor activity and fasting gastrointestinal peptide concentrations did not differ between groups at study 1, at study 2 early-fed infants had significantly more mature motor patterns than did babies not being fed. Early-fed infants also had significantly higher plasma concentrations of gastrin and gastric inhibitory peptide than did late-fed infants; neurotensin and peptide YY values were similar in both groups. By the time of study 3, when late-fed infants had also received enteral feedings, gut development was not different in the two groups. However, early-fed infants were able to tolerate full oral nutrition sooner, had fewer days of feeding intolerance, and had shorter hospital stays. Thus the provision of early hypocaloric nutrition was associated with earlier nutrition of preterm infants' intestinal function and resulted in improved feeding tolerance. These findings support the use of early feedings in preterm infants.