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Enteral nutrients promote postnatal maturation of intestinal motor activity in preterm infants
1Department of Pediatrics, Mayo Clinic, Rochester, Minnesota 55905.
Insights
Early formula feeding promotes preterm infant intestinal maturation. Delayed enteral feeding, even with water, impairs motor activity and delays full feeding establishment, impacting non-mucosal gut functions.
Area of Science:
- Neonatology
- Gastroenterology
- Developmental Biology
Background:
- Preterm infants often require nutritional support via parenteral nutrition.
- The role of early enteral feeding in promoting intestinal maturation in preterm infants is critical.
- Understanding the impact of feeding composition on gut motility is essential for optimizing care.
Purpose of the Study:
- To assess the chronic effects of nutrient versus non-nutrient enteral feeding on the functional maturation of the preterm intestine.
- To evaluate the impact of early feeding on intestinal motor activity patterns and clinical outcomes.
- To determine if early water supplementation influences the development of intestinal motor function.
Main Methods:
- Low-compliance perfusion manometry was used to measure intestinal motor activity in 32 preterm infants.
- Infants were randomized to receive either formula or sterile water supplementation to parenteral nutrition.
- Clinical outcomes, including time to full enteral nutrition and nipple feeding, were monitored.
Main Results:
- Infants receiving early formula feeding exhibited enhanced migrating motor activity and reduced clustered phasic activity during fasting.
- Nutrient-fed infants showed a distinct motor response to feeding, unlike water-fed infants.
- Water-fed infants, after switching to formula, normalized motor patterns but were delayed in achieving full enteral and nipple feeding.
Conclusions:
- Early enteral nutrient feeding is crucial for the functional maturation of the preterm intestine, particularly non-mucosal functions.
- Delaying enteral feeding with non-nutrients like water can impair intestinal motor development and delay feeding progression.
- Optimizing the timing and composition of early enteral nutrition is vital for improving outcomes in preterm infants.
Abstract:
Low-compliance perfusion manometry and clinical outcome were used to assess the chronic effects of feeding on functional maturation of the preterm intestine in 32 infants. During the first postnatal week, 16 infants received a small volume of formula to supplement their routine parenteral nutrition (24 ml.kg-1.day-1), and 16 received an equal volume of water. After 10 days of enteral "feedings," the manometric tracings of those infants who had received nutrient feedings had more migrating activity (P < 0.01) and less clustered phasic activity (P < 0.05) during fasting than did the tracings of those infants who had received nonnutrient feedings containing sterile water. Infants who received nutrient feedings demonstrated a change in motor activity in response to feeding; infants who had received water feedings failed to show a change in motor activity in response to feeding. After water-fed infants were given formula feedings for 2 wk, their motor activity patterns were similar to those who had initially been fed formula, and their motor responses to feeding were restored. Despite normalization of their motor activity patterns by 1 mo of age, these water-fed infants established full enteral nutrition and full nipple feedings later than did infants who had been fed formula (P < 0.01), suggesting that the delay of enteral feedings in preterm infants does not permit optimal intestinal maturation of nonmucosal functions.