REVIEW

Feeding growth restricted preterm infants with abnormal antenatal Doppler results

J Dorling¹, S Kempley², A Leaf³

¹ Department of Health Sciences, University of Leicester, Leicester LE2 7LX, UK
² Barts and the London NHS Trust, Whitechapel, London E1 1BB, UK
³ Neonatal Unit, Southmead Hospital, Westbury on Trym, Bristol BS10 5NB, UK

Correspondence to:
Correspondence to:
Dr Dorling
Department of Health Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, PO Box 65, Leicester LE2 7LX, UK; jsd10{at}le.ac.uk

Absence or reversal of end diastolic flow (AREDF) in the umbilical artery is associated with poor outcome, and elective premature delivery is common. Feeding these infants is a challenge. They often have poor tolerance of enteral feeding, and necrotising enterocolitis may develop. This review explores current practice to see if there is evidence on which to base guidelines. The incidence of necrotising enterocolitis is increased in infants with fetal AREDF, especially when complicated by fetal growth restriction. Abnormalities of splanchnic blood flow persist postnatally, with some recovery during the first week of life, providing justification for a delayed and careful introduction of enteral feeding. Such a policy exposes babies to the risks of parenteral nutrition, with no trials to date showing any benefit of delayed enteral nutrition. Trials are required to determine the optimum timing for introduction of enteral feeds in growth restricted infants with fetal AREDF.

Abbreviations: AREDF, absence or reversal of end diastolic flow; IUGR, intrauterine growth restriction; MEF, minimal enteral feeding; NEC, necrotising enterocolitis; SGA, small for gestational age; SMA, superior mesenteric artery

Keywords: absence or reversal of end diastolic flow; enteral feeding; intrauterine growth restriction; necrotising enterocolitis; prematurity

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