Enteral administration of a simulated amniotic fluid in preventing feeding intolerance in very low birthweight neonates: A randomized controlled trial

•Feeding intolerance is a common finding in preterm neonates.•Enteral administration of different forms of amniotic fluid has been tried in the treatment of feeding intolerance in high-risk neonates.•Simulated amniotic fluid is a solution with a similar electrolyte composition to human amniotic flui...

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Published in:Nutrition (Burbank, Los Angeles County, Calif.) Los Angeles County, Calif.), 2023-03, Vol.107, p.111932-111932, Article 111932
Main Authors: El-Farrash, Rania A., Ismail, Rania I.H., El-Sheimy, Mohamed S., Saleh, Ahmed M., Saleh, Ghada A.
Format: Article
Language:English
Subjects:
Abdomen
Amniotic Fluid
Babies
Birth weight
Breastfeeding & lactation
Calories
Congenital anomalies
Congenital defects
Energy Intake
Enteral amniotic fluid
Enteral EPO
Enteral G-CSF
Enteral nutrition
Enterocolitis
Enterocolitis, Necrotizing - epidemiology
Enterocolitis, Necrotizing - prevention & control
Erythropoietin
Feeding
Feeding intolerance
Fetuses
Humans
Infant, Newborn
Infant, Premature
Infant, Very Low Birth Weight
Intolerance
Leukocytes (granulocytic)
NEC
Necrotizing enterocolitis
Neonates
Newborn babies
Pharmacists
Statistics
VLBW
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Summary:•Feeding intolerance is a common finding in preterm neonates.•Enteral administration of different forms of amniotic fluid has been tried in the treatment of feeding intolerance in high-risk neonates.•Simulated amniotic fluid is a solution with a similar electrolyte composition to human amniotic fluid.•The smooth transition in the process of gastrointestinal maturation perinatally might be attributed to the existence of intestinal trophic factors and bioactive peptides that are common in both amniotic fluid and human milk•The simulated amniotic fluid group reached significantly larger volume and higher calories on days 3 and 7 (P < 0.05 for all). Feeding intolerance (FI) is a common finding in preterm neonates. Enteral administration of different forms of amniotic fluid (AF) has been tried for treating FI in high-risk neonates. Simulated amniotic fluid (SAF) is a solution with a similar electrolyte composition to human AF. The aim of this study was to examine whether enteral administration of SAF would improve feeding tolerance in very low birthweight (VLBW) neonates. Forty VLBW neonates were randomized to either SAF or placebo (total daily dose 20 mL/kg/d–1 divided every 3 h) to their milk for a maximum of 7 d. Neonates with major congenital anomalies, those in whom early feeding was contraindicated, and those treated with parental erythropoietin and/or human granulocyte stimulating factor were excluded. The primary outcome was the total amount of enteral feeds reached by day 7. Secondary outcomes were incidence of FI and necrotizing enterocolitis (NEC). Study intervention was stopped on completing 7 d, reaching enteral feeds of 100 mL/kg/d–1, or the appearance of any sign of FI or NEC. All neonates tolerated the test solution well. The SAF group reached significantly larger volume and higher calories on days 3 and 7 (P < 0.05 for all). No statistical differences were seen between the two groups in incidence of FI (P = 0.311), NEC (P = 0.429), mortality (P = 0.632), length of stay (P = 0.744), or weight gain on day 10 (P = 0.389). Baseline hematologic parameters showed no statistical differences before or after enteral administration (P > 0.05). Results of the present study demonstrated that SAF solution might improve feeding tolerance in VLBW babies without evidence of its systemic absorption. Larger multicenter randomized studies are recommended.
ISSN:0899-9007
1873-1244
DOI:10.1016/j.nut.2022.111932