ORIGINAL ARTICLE

Minimal enteral feeding, fetal blood flow pulsatility, and postnatal intestinal permeability in preterm infants with intrauterine growth retardation

R M van Elburg¹, A van den Berg¹, C M Bunkers², R A van Lingen², E W A Smink², J van Eyck³, W P F Fetter¹

¹ Department of Paediatrics, Division of Neonatology, VU University Medical Centre, Amsterdam, the Netherlands
² Department of Paediatrics, Division of Neonatology, Isala Clinics location Sophia, Zwolle, the Netherlands
³ Department of Obstetrics, Isala Clinics location Sophia, Zwolle, the Netherlands

Correspondence to:
Correspondence to:
Dr van Elburg
Department of Paediatrics, Division of Neonatology, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; rm.vanelburg{at}vumc.nl

Objective: To study the effect of minimal enteral feeding (MEF) on intestinal permeability and feeding tolerance in preterm infants with intrauterine growth retardation (gestational age < 37 weeks, birth weight for gestational age p < 10). Furthermore, to determine whether fetal blood flow pulsatility or intestinal permeability predict feeding tolerance in these infants.

Design: Randomised controlled trial.

Methods: Within 48 hours of birth, infants were randomised to MEF or no enteral feeding (NEF) for five days in addition to parenteral feeding. Intestinal permeability was measured by the sugar absorption test before (SAT1) and after (SAT2) the study. The sugar absorption test measured the urinary lactulose/mannitol (LM) ratio after oral ingestion of a solution (375 mosm) containing mannitol and lactulose. Charts of all infants were assessed for measures of feeding tolerance. Fetal blood flow pulsatility index (U/C ratio) was measured within the seven days before birth.

Results: Of the 56 infants enrolled, 42 completed the study: 20 received MEF and 22 NEF. The decrease in LM ratio (LM ratio 1 – LM ratio 2) was not significantly different between the two groups (0.25 v 0.11; p  =  0.14). Feeding tolerance, growth, and incidence of necrotising enterocolitis were not significantly different between the two groups. Neither the U/C nor the LM ratio 1 predicted feeding tolerance.

Conclusions: The results suggest that MEF of preterm infants with intrauterine growth retardation has no effect on the decrease in intestinal permeability after birth. Neither fetal blood flow pulsatility nor intestinal permeability predicts feeding tolerance.

Abbreviations: MEF, minimal enteral feeding; NEC, necrotising enterocolitis; NEF, no enteral feeding; PI, pulsatility index; SAT, sugar absorption test; IUGR, intrauterine growth retardation

Keywords: fetal blood flow pulsatility; intestinal permeability; fetal growth retardation; preterm infant; enteral nutrition

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