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Feed intolerance in preterm neonates with antenatal reverse end diastolic flow (REDF) in umbilical artery: a

Abhishek Somasekhara Aradhya1, Kanya Mukhopadhyay1, Shiv Sajan Saini1

  • 1Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

The Journal of Maternal-Fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
|October 31, 2018
PubMed

Insights

Feed intolerance is common in neonates with antenatal reverse end-diastolic flow (REDF), but the risk of necrotizing enterocolitis (NEC) is not significantly elevated. Early enteral feeding can be safely initiated in these infants with careful monitoring.

Area of Science:

  • Neonatalogy
  • Perinatology
  • Gastroenterology

Background:

  • Antenatal absent or reverse end-diastolic flow (AREDF) in growth-restricted infants is linked to feed intolerance.
  • Reverse end-diastolic flow (REDF) is presumed to cause more severe feeding issues, but its natural history is poorly understood.

Purpose of the Study:

  • To investigate the incidence of feed intolerance and necrotizing enterocolitis (NEC) in preterm neonates diagnosed with antenatal REDF.
  • To assess the time to achieve full enteral feeding in this population.

Main Methods:

  • Retrospective cohort study of preterm infants (<37 weeks gestation) with antenatal REDF diagnosed between January 2015 and September 2017.
  • Primary outcomes included feed intolerance, NEC, and time to full enteral feeding (150 ml/kg/day).

Main Results:

  • Of 48 eligible neonates, 45% experienced feed intolerance, requiring temporary cessation of feeds.
  • Full enteral feeds were achieved by a median age of 9 days.
  • Only 6% of neonates developed NEC (Bell's stage 2 or higher).

Conclusions:

  • Feed intolerance is a frequent complication in neonates with antenatal REDF.
  • The risk of developing NEC in this cohort is not higher than in cases of absent end-diastolic flow (AEDF).
  • Early enteral feeding (around 24 hours) appears safe in REDF infants without abdominal symptoms.

Keywords:
Feed advancementReverse end diastolic flowfeed initiationfeed intolerancenecrotizing enterocolitis

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