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Feeding issues in IUGR preterm infants

Valentina Bozzetti1, Paolo E Tagliabue, Gerard H A Visser

  • 1Neonatal Intensive Care Unit, MBBM Foundation, San Gerardo Hospital, Monza, Italy.

Early Human Development
|July 27, 2013
PubMed

Intra-uterine growth restriction (IUGR) is a severe and quite common problem in obstetrics. A condition of placental dysfunction can lead to a cardiovascular adaptation in the fetus characterized by a redistribution of cardiac output to maintain oxygen supply to the heart, adrenal glands and brain - the so-called brain sparing effect - at the expense of visceral organs (such as the gastrointestinal system). This condition may predispose IUGR infants to impaired gut function after birth. A higher incidence of necrotizing enterocolitis (NEC) is documented in IUGR preterm infants. Therefore, a common practice in neonatal intensive care units is to delay feeds to reduce the risk of feeding intolerance. Recent trials, however, have shown that early enteral feeding in IUGR infants is safe and it would appear, on the basis of the few available data, that breast milk could offer protection against NEC. This mini-review offers an update on feeding in IUGR infants. Future perspectives on the usefulness of Doppler and regional splanchnic and cerebral saturation monitoring for deciding when to start feeding are also provided.

Keywords:
ACOGAGAAREDAmerican College of Obstetricians and GynecologistsBSBWBrain sparingFEFFeeding toleranceIUGRMCAMEFNECNICUNIRSNecrotizing enterocolitisPISGATPNU/CUAVLBWabsent/reverse end-diastolic flowadequate for gestationalbirth weightbrain sparingcerebroplacental ratiofull enteral feedingintra-uterine growth restrictionmiddle cerebral arteryminimal enteral feedingnear infrared spectroscopynecrotizing enterocolitisneonatal intensive care unitpulsatility indexsmall for gestational agetotal parenteral nutritionumbilical arteryvery low birth weight

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