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Enteral administration of a simulated amniotic fluid in preventing feeding intolerance in very low birthweight
Rania A El-Farrash1, Rania I H Ismail1, Mohamed S El-Sheimy1
1Pediatrics Departments, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Insights
Simulated amniotic fluid (SAF) improved feeding tolerance in very low birthweight (VLBW) neonates. This intervention increased enteral feed volumes and calories without affecting feeding intolerance or necrotizing enterocolitis rates.
Area of Science:
- Neonatology
- Gastroenterology
- Pediatric Nutrition
Background:
- Feeding intolerance (FI) is a significant challenge in preterm neonates.
- Enteral administration of amniotic fluid (AF) has shown promise in managing FI.
- Simulated amniotic fluid (SAF) offers a standardized alternative with similar electrolyte composition to AF.
Purpose of the Study:
- To evaluate the efficacy of enteral SAF administration in improving feeding tolerance in very low birthweight (VLBW) neonates.
- To assess the impact of SAF on enteral feed advancement and key neonatal outcomes.
- To determine if SAF is systemically absorbed in VLBW infants.
Main Methods:
- A randomized controlled trial involving 40 VLBW neonates.
- Participants received either SAF or placebo added to their milk feeds for up to 7 days.
- Primary outcome was the total enteral feed volume reached by day 7; secondary outcomes included FI and necrotizing enterocolitis (NEC) incidence.
Main Results:
- The SAF group achieved significantly higher enteral feed volumes and caloric intake on days 3 and 7 (P < 0.05).
- No significant differences were observed in the incidence of FI, NEC, mortality, length of stay, or weight gain between groups.
- Hematologic parameters remained stable, indicating no systemic absorption of SAF.
Conclusions:
- Enteral SAF administration may enhance feeding tolerance in VLBW neonates.
- SAF appears to be safe and well-tolerated, with no evidence of systemic absorption.
- Larger multicenter randomized trials are recommended to confirm these findings.
Objectives:
Feeding intolerance (FI) is a common finding in preterm neonates. Enteral administration of different forms of amniotic fluid (AF) has been tried for treating FI in high-risk neonates. Simulated amniotic fluid (SAF) is a solution with a similar electrolyte composition to human AF. The aim of this study was to examine whether enteral administration of SAF would improve feeding tolerance in very low birthweight (VLBW) neonates.
Methods:
Forty VLBW neonates were randomized to either SAF or placebo (total daily dose 20 mL/kg/d-1 divided every 3 h) to their milk for a maximum of 7 d. Neonates with major congenital anomalies, those in whom early feeding was contraindicated, and those treated with parental erythropoietin and/or human granulocyte stimulating factor were excluded. The primary outcome was the total amount of enteral feeds reached by day 7. Secondary outcomes were incidence of FI and necrotizing enterocolitis (NEC). Study intervention was stopped on completing 7 d, reaching enteral feeds of 100 mL/kg/d-1, or the appearance of any sign of FI or NEC.
Results:
All neonates tolerated the test solution well. The SAF group reached significantly larger volume and higher calories on days 3 and 7 (P < 0.05 for all). No statistical differences were seen between the two groups in incidence of FI (P = 0.311), NEC (P = 0.429), mortality (P = 0.632), length of stay (P = 0.744), or weight gain on day 10 (P = 0.389). Baseline hematologic parameters showed no statistical differences before or after enteral administration (P > 0.05).
Conclusion:
Results of the present study demonstrated that SAF solution might improve feeding tolerance in VLBW babies without evidence of its systemic absorption. Larger multicenter randomized studies are recommended.
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