Evaluation of Feeding Torerance in Intrauterine Growth Restricted Preterm Infants

Abstract

Intra Uterine Growth Restriction (IUGR) is an important and common problem in obstetrics. The purpose of the present thesis was to investigate: 1. Feeding issues in IUGR preterm infants; 2. Clinical and strumental parameters as predictors of feeding tolerance in IUGR preterm infants; 3. Splanchnic and cerebral oxygenation patterns in IUGR and non IUGR infants; 4. Splanchnic oxygenation and perfusion patterns in IUGR and non IUGR infants after feeding by bolus and by continuous enteral nutrition; We outlined that the prolonged time necessary to achieve full enteral feeding may be ascribed to a chronic prenatal intestinal hypoxic condition and IUGR infants with brain sparing had worse feeding tolerance than IUGR infants with no fetal hypoxia. We also demonstrated that cerebral/splanchnic vascular adaptation of IUGR infants to the extra-uterine environment was characterized by a postnatal persistence of the brain sparing effect with reperfusion occurring in the transitional period. Results from the RCT we conducted revealed that bolus feeding was more effective in increasing the splanchnic blood flow when compared to continuous feeding. IUGR and NON IUGR infants showed similar oxygenation and perfusion patterns after feeding. Results from the trial suggested that bolus feeding seems to be more prone to promote feeding tolerance by increasing intestinal perfusion, but continuous feeding appears to be a more prudent approach in those haemodinamically unstable patients. These findings on feeding intervention, firstly reported in the scientific literature, provide evidence about which feeding method is to prefer according to the clinical condition of the patient.