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Updated: Aug 16, 2026
Fetal Echocardiography and Pulsed-wave Doppler Ultrasound in a Rabbit Model of Intrauterine Growth Restriction
Published on: June 29, 2013
Feeding growth restricted preterm infants with abnormal antenatal Doppler results
1Department of Health Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, PO Box 65, Leicester LE2 7LX, UK. jsd10@le.ac.uk
Insights
Infants with absent or reversed end-diastolic flow (AREDF) in umbilical arteries face feeding challenges and increased necrotising enterocolitis risk. Evidence is lacking for optimal enteral feeding timing in these high-risk newborns.
Area of Science:
- Neonatalogy
- Perinatology
- Pediatric Gastroenterology
Background:
- Absence or reversal of end-diastolic flow (AREDF) in the umbilical artery is linked to adverse perinatal outcomes.
- Infants with AREDF often exhibit poor enteral feeding tolerance and a higher incidence of necrotising enterocolitis, particularly when complicated by fetal growth restriction.
Purpose of the Study:
- To review current practices regarding enteral feeding in infants with fetal AREDF.
- To identify evidence gaps and inform the development of clinical guidelines for feeding these vulnerable infants.
Main Methods:
- Systematic review of current literature and clinical practices.
- Analysis of the incidence of necrotising enterocolitis in infants with AREDF and fetal growth restriction.
- Examination of postnatal splanchnic blood flow dynamics and their implications for feeding.
Main Results:
- The incidence of necrotising enterocolitis is elevated in infants with fetal AREDF, especially with co-existing fetal growth restriction.
- Postnatal splanchnic blood flow abnormalities persist, with gradual recovery observed in the first week of life.
- Current delayed enteral feeding policies lack supporting trial evidence and may increase reliance on parenteral nutrition.
Conclusions:
- A delayed and cautious approach to enteral feeding is suggested by persistent postnatal splanchnic blood flow abnormalities.
- There is a critical need for clinical trials to establish the optimal timing for initiating enteral feeds in growth-restricted infants experiencing fetal AREDF.
- Current evidence does not support the benefits of delayed enteral nutrition, highlighting risks associated with parenteral nutrition.
Abstract:
Absence or reversal of end diastolic flow (AREDF) in the umbilical artery is associated with poor outcome, and elective premature delivery is common. Feeding these infants is a challenge. They often have poor tolerance of enteral feeding, and necrotising enterocolitis may develop. This review explores current practice to see if there is evidence on which to base guidelines. The incidence of necrotising enterocolitis is increased in infants with fetal AREDF, especially when complicated by fetal growth restriction. Abnormalities of splanchnic blood flow persist postnatally, with some recovery during the first week of life, providing justification for a delayed and careful introduction of enteral feeding. Such a policy exposes babies to the risks of parenteral nutrition, with no trials to date showing any benefit of delayed enteral nutrition. Trials are required to determine the optimum timing for introduction of enteral feeds in growth restricted infants with fetal AREDF.
