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Late Enteral Feedings Are Associated with Intestinal Inflammation and Adverse Neonatal Outcomes
Yelizaveta Konnikova1, Munir M Zaman2, Meher Makda2
1Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, Unites States of America.
Insights
Delaying enteral nutrition in preterm infants increases risks for chronic lung disease and other morbidities. Early feeding is crucial for immune development and better neonatal outcomes.
Area of Science:
- Neonatal immunology
- Gastroenterology
- Perinatal medicine
Background:
- Preterm infants frequently experience impaired immunity and inflammation.
- Intestinal development is vital for immune maturation, influenced by diet.
- Enteral nutrition plays a key role in neonatal immune system development.
Purpose of the Study:
- To investigate how the timing of initial enteral feeding affects intestinal inflammation.
- To assess the impact of feeding timing on disease risk in preterm infants.
Main Methods:
- Studied 130 infants with gestational age <33 weeks.
- Collected maternal and infant data from medical records.
- Quantified cytokine levels (IL-8, IL-10) in fecal and serum samples using ELISA.
Main Results:
- Delayed enteral feeding (after day 3) increased risks of chronic lung disease (4.5-fold), retinopathy of prematurity (2.9-fold), and comorbidities (3.4-fold).
- Delayed feeding correlated with higher fecal IL-8 levels and a lower IL-10:IL-8 ratio, indicating increased inflammation.
- Early enteral nutrition (by day 3) was associated with reduced disease risks.
Conclusions:
- Delayed enteral feeding is linked to intestinal inflammation and higher morbidity rates in preterm infants.
- Re-evaluating early nutritional strategies is essential for improving neonatal health outcomes.
- Prompt initiation of enteral nutrition may mitigate risks and enhance infant well-being.
Background:
Morbidities of impaired immunity and dysregulated inflammation are common in preterm infants. Postnatal Intestinal development plays a critical role in the maturation of the immune system and is, in part, driven by exposure to an enteral diet.
Objective:
The aim of this study was to evaluate the influence of the timing of the first enteral feeding on intestinal inflammation and risk of disease.
Methods:
130 infants <33 weeks' gestation were studied. Maternal and infant data were abstracted from the medical record. Single and multiplex ELISA assays quantified cytokines from fecal and serum samples at two weeks postnatal age.
Results:
A delay in enteral feedings after the third postnatal day is associated with a 4.5 (95% CI 1.8-11.5, p=0.002) fold increase in chronic lung disease, 2.9 (1.1-7.8, p=0.03) fold increase in retinopathy of prematurity, and 3.4 (1.2-9.8, p=0.02) fold increase in multiple comorbidities compared to infants fed on or before the third day. Additionally, a delay in the initiation of feedings is associated with increased fecal IL-8 levels and a decreased IL-10:IL-8 ratio.
Conclusions:
A delay in enteral feeding is associated with intestinal inflammation and increased risks of morbidities. To improve neonatal outcomes, early nutritional practices need to be reevaluated.
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