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Gastric emptying of different meal volumes of identical composition in preterm infants: a time series analysis
Sharon L Perrella1, Anna R Hepworth1, Zoya Gridneva1
1School of Molecular Sciences, The University of Western Australia, Crawley, Perth, Western Australia, Australia.
Insights
Preterm infants fed smaller meal volumes experience slower gastric emptying (GE). Stable preterm infants may tolerate 3-hour feeding intervals with larger volumes, optimizing enteral nutrition.
Area of Science:
- Neonatal nutrition
- Pediatric gastroenterology
- Infant physiology
Background:
- Preterm infants' nutritional needs increase with age, requiring progressive adjustments in enteral feeding volumes.
- Understanding gastric emptying (GE) dynamics in response to varying meal volumes is crucial for optimizing feeding protocols in preterm neonates.
- Current knowledge gaps exist regarding the impact of meal volume and composition on GE in this vulnerable population.
Purpose of the Study:
- To investigate the influence of reduced meal volumes on gastric emptying (GE) in preterm infants.
- To assess the effect of milk composition, specifically casein concentration, on GE rates.
- To determine the optimal feeding interval for preterm infants based on GE patterns.
Main Methods:
- Forty preterm infants (33.3±1.4 weeks postmenstrual age) were studied using serial stomach ultrasound to measure gastric residual volumes (GRVs) and % meal.
- Intraindividual comparisons were made between 100% and 75% prescribed volumes of mother's own milk or pasteurized donor human milk.
- Gastric emptying (GE) was analyzed in relation to feeding intervals (2 vs. 3 hours) and milk casein content.
Main Results:
- Gastric emptying (GE) was faster initially and slowed over time. Reduced volume meals exhibited slower GE rates and lower GRVs (P<0.001).
- Higher milk casein concentration correlated with slower GE (P=0.04). Complete gastric emptying was more frequent with 3-hour feeding intervals compared to 2-hour intervals (P=0.002).
- % meal remaining postprandially was similar between reduced and full volume meals (P=0.41).
Conclusions:
- Early postprandial GE is more rapid with larger meal volumes in preterm infants.
- Preterm infants' GE is influenced by meal volume and milk composition (casein).
- Stable preterm infants may tolerate feeding a 3-hour volume at shorter intervals, suggesting potential for optimized feeding schedules.
Abstract:
BackgroundPreterm infants' meals typically progress to higher volumes over time. Knowledge of gastric emptying (GE) responses to differing meal volumes may inform enteral feeding management. We examined the effect of meal volume and composition on preterm GE.MethodsForty infants were studied at 33.3±1.4 (29.7-35.6) weeks postmenstrual age when fully enteral fed (target 150 ml/kg/day). Intraindividual comparisons of GE were made for paired meals of 100% and 75% prescribed volume and identical composition of mother's own milk (n=21) and pasteurized donor human milk (n=19). Serial stomach ultrasound images were used to calculate gastric residual volumes (GRVs) and remaining meal proportions (% meal).ResultsGE was faster in the early postprandial period and slowed over time (P<0.001). Reduced volume meals had slower GE rates and lower GRV (P<0.001). Serial postprandial % meal was similar between reduced and full volume meals (P=0.41). Higher milk casein concentration was associated with slower GE (P=0.04). Complete gastric emptying (GRV=0 ml) was more common in infants fed at 3 h intervals compared with those fed every 2 h (P=0.002).ConclusionEarly postprandial GE is more rapid for larger meal volumes. Stable preterm infants may tolerate feeding of a 3 h meal volume at shorter intervals.
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