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Gastric emptying in preterm infants
A K Ewer1, G M Durbin, M E Morgan
1Maternity Hospital, Birmingham.
Insights
Expressed breast milk empties twice as fast as formula milk in preterm infants. This faster gastric emptying of breast milk may improve feeding tolerance in vulnerable newborns.
Area of Science:
- Neonatal Physiology
- Gastroenterology
- Pediatric Nutrition
Background:
- Preterm infants often experience feeding intolerance due to delayed gastric emptying.
- Understanding factors influencing gastric emptying is crucial for optimizing nutrition in neonates.
- Breast milk is the preferred nutrition source for preterm infants, but its effect on gastric emptying requires further elucidation.
Purpose of the Study:
- To compare gastric emptying rates between expressed breast milk and formula milk in preterm infants.
- To evaluate the reproducibility of an ultrasonic technique for assessing gastric emptying.
- To determine the clinical implications of differential gastric emptying for feeding intolerance in neonates.
Main Methods:
- A blind, cross-over study design was employed with 14 preterm infants (median gestational age 33 weeks).
- Gastric emptying was assessed using real-time ultrasound to measure antral cross-sectional area (ACSA) changes post-feed.
- Half emptying time (50% delta ACSA) was calculated, representing the time for ACSA to reduce by half its post-feed increment.
Main Results:
- Expressed breast milk demonstrated significantly faster gastric emptying compared to formula milk (mean 50% delta ACSA: 36 minutes vs. 72 minutes).
- The ultrasonic technique proved reproducible, with consistent emptying rates for individual infants across feeds of the same type.
- Gastric emptying of expressed breast milk was approximately twice as rapid as that of formula milk.
Conclusions:
- Breast milk significantly accelerates gastric emptying in preterm infants compared to formula.
- This finding suggests a potential mechanism for improved feeding tolerance with breast milk in this population.
- The ultrasonic method is a reliable tool for assessing gastric emptying dynamics in preterm neonates.
Abstract:
An ultrasonic technique was used to compare gastric emptying after a feed of expressed breast milk and formula milk in a blind, cross over study of preterm infants. Fourteen infants (median gestational age 33 weeks) were studied on 46 occasions. Each infant received a nasogastric feed of either expressed breast milk or formula milk, and the alternative at the next feed. Real time ultrasound images of the gastric antrum were obtained and measurements of antral cross sectional area (ACSA) were made before the feed and then sequentially after its completion until the ACSA returned to its prefeed value. The half emptying time (50% delta ACSA) was calculated as the time taken for the ACSA to decrease to half the maximum increment. On average, expressed breast milk emptied twice as fast as formula milk: mean 50% delta ACSA expressed breast milk 36 minutes; formula milk 72 minutes. The technique was reproducible and there was no significant difference between the emptying rates of feeds of the same type for an individual infant. These data show that breast milk has a major effect on gastric emptying, which may have important implications for preterm infants who have a feed intolerance due to delayed gastric emptying.