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Nutrition of the preterm infant with persistent ductus arteriosus: existing evidence and practical implications
Chiara Lembo1, Afif El-Khuffash2, Christoph Fusch3,4
1Department of Neonatology, APHP, Necker-Enfants Malades Hospital, Paris, France.
Insights
Persistent ductus arteriosus (PDA) in preterm infants often causes gastrointestinal issues, complicating nutritional care. Enteral nutrition is generally recommended for PDA infants, but more research is needed for optimal feeding guidelines.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Cardiology
Background:
- Patent ductus arteriosus (PDA) is prevalent in preterm infants, with incidence inversely related to gestational age.
- PDA is linked to significant gastrointestinal complications, including feeding intolerance, perforation, and necrotizing enterocolitis, challenging nutritional management.
- These complications pose a major obstacle to achieving adequate nutritional intake, potentially impacting growth and long-term health in vulnerable preterm infants.
Purpose of the Study:
- To review current knowledge on nutritional management for preterm infants with PDA.
- To discuss the clinical implications of PDA on nutritional practices in this population.
- To identify gaps in research and advocate for the development of evidence-based guidelines.
Main Methods:
- This is a narrative review synthesizing existing literature.
- It involves collaboration between the European Society for Pediatric Research's Nutrition, Gastroenterology and Metabolism and Circulation Sections.
- The review focuses on the intersection of PDA, nutrition, and preterm infant care.
Main Results:
- PDA presence does not significantly impair mesenteric blood flow or splanchnic oxygenation during enteral feeding.
- Fluid restriction in PDA infants may lead to insufficient nutrient intake, negatively affecting growth.
- Initiation or continuation of enteral nutrition is advisable for infants diagnosed with PDA.
Conclusions:
- Enteral nutrition can be safely initiated or maintained in preterm infants with PDA.
- Further well-designed research is crucial to establish clear guidelines for nutritional support before, during, and after PDA treatment.
- Development of specific guidelines is needed to optimize enteral nutrition implementation and targets for preterm infants with PDA.
Abstract:
The persistence of a patent ductus arteriosus (PDA) is a common condition in preterm infants with a prevalence inversely proportional to gestational age. PDA is associated with mild-to-severe gastrointestinal complications such as feeding intolerance, gastrointestinal perforation, and necrotizing enterocolitis, which represent a major challenge for the nutritional management in preterm infants. In this context, the Section on Nutrition, Gastroenterology and Metabolism and the Circulation Section of the European Society for Pediatric Research have joined forces to review the current knowledge on nutritional issues related to PDA in preterm infants. The aim of the narrative review is to discuss the clinical implications for nutritional practice. Because there is little literature on postnatal nutrition and PDA in preterm infants, further research with well-designed studies on this topic is urgently needed. Guidelines should also be developed to clearly define the implementation and course of enteral nutrition and the target nutritional intake before, during, and after pharmacologic or surgical treatment of PDA, when indicated. IMPACT: Persistent ductus arteriosus (PDA) is associated with gastrointestinal complications such as feeding intolerance, gastrointestinal perforation, and necrotizing enterocolitis, which pose a major challenge to the nutritional management of preterm infants. In PDA infants, fluid restriction may lead to inadequate nutrient intake, which may negatively affect postnatal growth and long-term health. The presence of PDA does not appear to significantly affect mesenteric blood flow and splanchnic oxygenation after enteral feedings. Initiation or maintenance of enteral nutrition can be recommended in infants with PDA.
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