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Strategies for prevention of feed intolerance in preterm neonates: a systematic review
1Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women and University of Western Australia, Perth, Australia. Sanjay.Patole@health.wa.gov.au
Insights
Optimizing enteral nutrition for preterm infants is crucial for growth and neurodevelopment. Current feeding strategies aim to prevent feed intolerance and necrotizing enterocolitis (NEC), but more research is needed.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Gastroenterology
Background:
- Postnatal growth restriction and failure to thrive are significant issues in preterm neonates, particularly those with extremely low birth weight.
- Delayed enteral feeding is linked to poorer neurodevelopmental outcomes in preterm infants at 24 months corrected age.
- Optimizing enteral nutrition while minimizing the risk of necrotizing enterocolitis (NEC) is a critical priority.
Purpose of the Study:
- To review current feeding strategies for preventing or minimizing feed intolerance in preterm neonates.
- To highlight the dilemma in defining feed intolerance signs and the fear of NEC.
- To emphasize the need for clinical research to establish a scientific basis for feeding strategies.
Main Methods:
- Systematic review of existing literature on feeding strategies for preterm neonates.
- Analysis of the challenges in identifying and managing feed intolerance.
- Discussion of the balance between aggressive enteral nutrition and the risks of NEC and parenteral nutrition.
Main Results:
- A variety of feeding strategies exist, but there is a lack of consensus on defining feed intolerance.
- The fear of NEC influences clinical decisions regarding enteral feeding.
- Further research is needed to develop evidence-based feeding protocols.
Conclusions:
- Further clinical research, particularly large pragmatic trials, is essential to guide optimal enteral nutrition strategies in preterm infants.
- Determining whether the benefits of aggressive enteral nutrition outweigh the risks of NEC and prolonged parenteral nutrition requires robust scientific evidence.
- Developing a scientific basis for feeding strategies will improve growth and long-term neurodevelopmental outcomes in preterm neonates.
Abstract:
Postnatal growth restriction and failure to thrive have been recently identified as a major issue in preterm, especially extremely-low-birth-weight neonates. An increased length of time to reach full enteral feedings is also significantly associated with a poorer mental outcome in preterm neonates at 24 months corrected age. Optimization of enteral nutrition without increasing the risk of necrotizing enterocolitis (NEC) has thus become a priority in preterm neonates. A range of feeding strategies currently exists for preventing/minimizing feed intolerance in preterm neonates reflecting the dilemma surrounding the definition and significance of signs of feed intolerance due to ileus of prematurity and the fear of NEC. The results of a systematic review of current strategies for preventing/minimizing feed intolerance in preterm neonates are discussed. The need for clinical research in the area of signs of feed intolerance is emphasized to develop a scientific basis to feeding strategies. Only large pragmatic trials based on such strategies will reveal whether the benefits (improved growth and long term neurodevelopmental outcomes) of aggressive enteral nutrition can outweigh the risks of a potentially devastating illness like NEC, and of prolonged parenteral nutrition in preterm neonates.
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