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The effect of drip versus intermittent feeding on splanchnic oxygenation in preterm infants with intrauterine growth restriction: a prospective randomized trial

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Abstract

The main purpose of this study was to evaluate the impact of drip versus intermittent feeding on splanchnic oxygenation in preterm infants with intrauterine growth restriction. The second objective was to assess the relationship between fetal splanchnic circulation parameters and splanchnic oxygenation during the first week of life. A single-center, prospective, randomized study with 51 fetuses/infants was conducted. Fetal Doppler measurements including umbilical artery, middle cerebral artery, and superior mesenteric artery (SMA) were recorded in IUGR fetuses. After preterm delivery, the infants were randomly assigned to one of two feeding modalities: drip (3-h continuous) or intermittent (bolus in 10 min). Continuous regional splanchnic saturation (rSO2S) monitoring was carried out during the first week of life, simultaneously with continuous oxygen arterial saturation (SaO2) monitoring, and the infants’ fractional oxygen extractions (FOE) were calculated. These parameters were evaluated as means on a daily basis for the first week of life, as well as pre-prandial and post-prandial measurements on the seventh day. Fetal Doppler flow velocimetry disturbances were present in 72.5% of the study cohort. The drip (26 infants) and intermittent (25 infants) groups were similar in demographic and clinical characteristics, as well as the prevalence of feeding intolerance and necrotizing enterocolitis. During the first week of life, there was no difference in daily mean rSO2S and FOE values between the drip and intermittent groups, whereas unfed infants had mostly lower rSO2S values. Pre-prandial and post-prandial rSO2S values remained stable in both groups. Also, no association was detected between fetal splanchnic circulation parameters and neonatal splanchnic oxygenation. RSO2S values were strongly correlated to gestational age and birth weight. During the whole week, except for the first 2 days, infants with umbilical catheters had significantly lower rSO2S values than infants without.

  Conclusion: Our data suggest that the key factor in splanchnic oxygenation is feeding, not the feeding modality. In addition, the umbilical vein catheter had a negative impact on splanchnic oxygenation.

  Clinical Trial Registration: The Effect of Neonatal Feeding Modalities on Splanchnic Oxygenation, NCT05513495, https://clinicaltrials.gov/ct2/results cond=&term=NCT05513495&cntry=TR&state=&city=&dist=. Retrospectively registered, date of registration: August 2022.

What is Known:

• It is known that preterm infants with IUGR are at increased risk of hypoxic-ischemic intestinal damage and impaired splanchnic oxygenation.

What is New:

• The key factor in splanchnic oxygenation of preterm infants with IUGR is feeding, not the feeding modality (drip or intermittent).

• In addition, the umbilical vein catheter had a negative impact on splanchnic oxygenation.

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Data availability

Data were recorded in SPSS. The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

AREDF:

Absent or reversed end-diastolic blood flow

DOL:

Day of life

FEF:

Full enteral feeding

FI:

Feeding intolerance

FMP:

First meconium passage

FOE:

Fractional oxygen extractions

IUGR:

Intrauterine growth restriction

MCA:

Middle cerebral artery

NEC:

Necrotizing enterocolitis

NICU:

Neonatal intensive care unit

NIRS:

Near-infrared spectroscopy

rSO2S:

Regional splanchnic saturation

SMA:

Superior mesenteric artery

SaO2 :

Oxygen arterial saturation

UA:

Umbilical artery

UAC:

Umbilical artery catheters

UVC:

Umbilical vein catheter

WOL:

Week of life

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Funding

This study was supported by Eskisehir Osmangazi University Scientific Research Projects Coordination Unit under grant no. 61690618-604.99-E.61140. There has been no involvement in study design, collection of analysis, interpretation of data, writing of the report, and decision to submit the manuscript for publication by Eskisehir Osmangazi University Scientific Research Projects Coordination Unit.

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Author notes

  1. Ozge Surmeli Onay and Melih Velipasaoğlu have contributed equally as the first authors of this article.

Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey

    Ozge Surmeli Onay, Merve Tutal, Tevhide Derya Sarılar, Adviye Cakıl Saglık, Ozge Aydemir, Tugba Barsan Kaya & Ayşe Neslihan Tekin

  2. Department of Obstetrics and Gynaecology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey

    Melih Velipasaoğlu & Huseyin Mete Tanır

  3. Department of Biostatistics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey

    Muzaffer Bilgin

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Contributions

Dr. Surmeli Onay: conceptualized and designed the study, coordinated and supervised data collection, carried out the initial analyses, drafted the initial manuscript, and reviewed and revised the manuscript. Drs. Velipasaoglu and Tanır: designed the data collection instruments, collected data, carried out the initial analyses, and reviewed and revised the manuscript. Dr. Surmeli Onay and Dr. Velipasaoglu have contributed equally as the first authors of this article. Drs. Tutal, Sarılar, and Cakil Saglık designed the data collection instruments, collected data, and carried out the initial analyses. Mr. Bilgin carried out the statistical analyses, and reviewed and revised the manuscript. Drs. Aydemir, Barsan Kaya, and Tekin coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content. Each author has seen and approved the submission of this version of the manuscript and takes full responsibility for the manuscript.

Corresponding author

Correspondence to Ozge Surmeli Onay.

Ethics declarations

Ethics approval

The study was performed in line with the Declaration of Helsinki and the Institutional Ethics Committee approved the study (No: 80558721–050.99-E.105607).

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Written informed consent was obtained from all subjects (from all parents or legal guardians).

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All the patient data are anonymized, and parents and legal guardians consented to the publication of the results of the project.

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The authors declare no competing interests.

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Communicated by Daniele De Luca.

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Supplementary file1 (JPG 18 KB)

431_2023_4810_MOESM2_ESM.docx

Supplementary file2 Supplement Figure The course of daily mean regional splanchnic oxygen saturation (rSO2S) measurements in infants with and without umbilical catheters during the first week of life. *p < 0.05 (JPG 99 KB)

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Surmeli Onay, O., Velipasaoğlu, M., Tutal, M. et al. The effect of drip versus intermittent feeding on splanchnic oxygenation in preterm infants with intrauterine growth restriction: a prospective randomized trial. Eur J Pediatr 182, 1317–1328 (2023). https://doi.org/10.1007/s00431-023-04810-x

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