Journal of Clinical Neonatology

ORIGINAL ARTICLE
Year
: 2016  |  Volume : 5  |  Issue : 4  |  Page : 230--232

Incidence of feeding intolerance in preterm neonates in neonatal intensive care units, Port Said, Egypt


Abdelmoneim Khashana, Rehab Moussa 
 Department of Pediatrics, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

Correspondence Address:
Dr. Abdelmoneim Khashana
41111 Ring Road, Suez Canal University Hospital, Ismailia
Egypt

Abstract

Introduction: The feeding of preterm neonates is one of the main challenges facing the neonatologist. Feeding intolerance can be defined by difficulty in ingestion or digestion of the milk that causes a disruption in the enteral feeding plan due to the manifestation of clinical symptoms. These symptoms include gastric residuals, emesis, abdominal distention, visible bowel loops, and change in the character of stool. Aim: To determine the incidence of feeding intolerance in preterm neonates. Methods: Study was carried out on 998 preterm neonates admitted at neonatal intensive care units of Port-Said in the period from 1st August 2014 till the 1st of March 2015. Inclusion criteria included Preterm infants of both genders from day 0 to day 28 of life and with gestational age from 28 to below 37 weeks (confirmed by maternal last menstrual period). Diagnosis of feeding intolerance depended on presence of one or more signs that leading to interruption of the enteral feeding regime of the preterm as; increased gastric residuals of the previous feeding, emesis, abdominal distention, bloody stool, diarrhea and visible bowel loops. Results: The incidence of feeding intolerance in preterm was 2.6%. Conclusion: The percentage of feeding intolerance in Port-Said, Egypt is 2.6% of the preterm neonate.



How to cite this article:
Khashana A, Moussa R. Incidence of feeding intolerance in preterm neonates in neonatal intensive care units, Port Said, Egypt.J Clin Neonatol 2016;5:230-232


How to cite this URL:
Khashana A, Moussa R. Incidence of feeding intolerance in preterm neonates in neonatal intensive care units, Port Said, Egypt. J Clin Neonatol [serial online] 2016 [cited 2021 Dec 2 ];5:230-232
Available from: https://www.jcnonweb.com/text.asp?2016/5/4/230/194165


Full Text

 Introduction



Preterm infants have higher nutrient requirements than term infants because they have missed some or all of the third trimester of pregnancy which is a period of nutrient accretion and rapid growth. The fetus multiplies in weight five times from 24 weeks gestation to term (a period <4 months); in comparison term infants double their birth weight by 4–5 months.[1]

The American Academy of Pediatrics policy statement in 2012 on breastfeeding and the use of human milk recommend human milk for term, preterm, and other high-risk infants either by direct breastfeeding and/or by expressed breast milk.[2]

Preterm infants, who have feeding intolerance, get difficulty with the ingestion or digestion of formula or breast milk and that lead to disruption in the current enteral feeding plan. Symptoms of feeding intolerance include the presence of gastric residuals, vomiting, abdominal distention, visible bowel loops, diarrhea, or bloody stool. Apnea, bradycardia, and temperature instability are also included as symptoms of feeding intolerance but solely for the purposes of the nursing assessment in order to provide guidance on identification of potential progression to more serious complications such as pneumatosis intestinalis and necrotizing enterocolitis.[3]

Factors that contribute to feeding intolerance include poor coordination of sucking and swallowing, incompetent lower esophageal sphincter, small gastric capacity, delayed gastric emptying time, and intestinal hypomotility.[4]

An abnormal bacterial colonization may be a coexisting factor in feeding intolerance in newborn mainly due to dysfunction of the intestinal barrier, the immune responses, and sensory motor functions of the gut. Abnormal intestinal colonization, poor balance between microbiota, immune response, and tolerance mechanisms may result in feeding intolerance in early postnatal life and in gastrointestinal disease in childhood.[5]

Aim

To determine the incidence of feeding intolerance in preterm neonates.

Settings and design

The study was carried out on 998 preterm neonates admitted to Neonatal Intensive Care Units of Port Said in the period from August 2014 till March, 1, 2015.

Inclusion criteria included preterm infants of both genders from day 0 to day 28 of life and with gestational age (GA) from 28 to below 37 weeks (confirmed by maternal last menstrual period).

 Materials and Methods



Diagnosis of feeding intolerance depended on the presence of one or more signs that leading to interruption of the enteral feeding regime of the preterm as increased gastric residuals (>50%) of the previous feeding, emesis, abdominal distention (increase in abdominal girth by 2 cm or more in between feedings), bloody stool, diarrhea, and visible bowel loops.[3]

Exclusion criteria included; neonates suffering from intestinal congenital anomalies,[6] neonates with fulminating sepsis from onset, also neonates with milk allergy.[6]

All the studied neonates were subjected to full history taking and full clinical examination.

Statistical analysis used

The collected data were organized, tabulated, and statistically analyzed using Statistical Package for Social Science; version 16 (SPSS, Inc., Chicago, IL, USA), running on IBM compatible computer.

Ethical consideration

Ethical approval for the study was obtained from the research Ethics Committee of the faculty of medicine Suez Canal University and written informed parental consent also was obtained. An informed consent was taken from each parent.

 Results



GA (weeks) ranged from 28 to 36 weeks with a mean of 32.26 ± 2.55 weeks. Birth weight ranged from 900 to 2750 g with a mean of 1898.65 ± 501.86 g. Time at feeding intolerance diagnosis ranged from 3 to 25 days. Twenty-six cases of the studied preterm had signs of feeding intolerance (2.6%).

Signs of feeding intolerance [Figure 1] in the 26 diagnosed cases ranged from vomiting in six cases (23.1%); vomiting and abdominal distension in five cases (19.2%); gastric residual and abdominal distension in seven cases (26.9%); abdominal distension, vomiting, apnea, and greenish residual in five cases (19.2%); vomiting with gastric residual in two cases (7.7%); and abdominal distension, vomiting, residual, and delayed gastric emptying in one case (3.8%).{Figure 1}

As regard to the presence of other morbidities [Table 1] in the cases with feeding intolerance, it was respiratory distress (RD) in 16 cases (61.5%), RD syndrome (RDS) in eight cases (30.8%), transient tachypnea of the newborn in one case (3.8%), RDS + hypoxic ischemic encephalopathy in one case (3.8%).{Table 1}

 Discussion



Feeding intolerance is one of the most common reasons to delay the advancement of enteral feeds or for suspension of feeds in preterm infants.[7]

In this prospective study, we followed preterm infants who were admitted to Port Said Neonatal Intensive Care Units in the period of August 2014 till March 2015 for the appearance of any signs of feeding intolerance. We assessed the incidence of feeding intolerance occurrence in this preterm.

Our patients had GA ranged from 28 to 36 weeks, a mean GA of 32.26 ± 2.55 weeks, a mean birth weight of 1898.65 ± 501.86 g, and a mean postnatal age at diagnosis of 10.03 ± 5.70 days. In the study of Zoppelli et al.,[8] mean GA was 28.5 weeks and birth weight 1057 g. In Albanna et al. study,[9] they had a mean GA of 32 weeks, a mean birth weight of 1500 g, and a mean age at diagnosis of 9 days. The study of Carroll et al.[10] had a mean GA of 30 weeks and mean age at diagnosis of 12 days. In Yang et al. study,[11] mean GA was 26.6 ± 2.1 weeks and mean birth weight was 982.1 ± 289.4 g. In Aydemir et al.[12] study, mean GA was 29 weeks, mean birth weight of 950 g, and a mean age of 14 days at diagnosis.

From a total of 998 neonates, 26 preterms showed signs of feeding intolerance. The incidence of feeding intolerance in our study was 2.6%. Five of the 26 feeding intolerance cases (9.6%) had suspected necrotizing enterocolitis (bell's stage IA); all of them have recovered completely except one case that died during the study.

In Aydemir et al. study,[12] three patients had mild necrotizing enterocolitis (Bell's stage IB), four had definite necrotizing enterocolitis (Bell's stage IIB), and three had clinical signs consistent with advanced necrotizing enterocolitis (Bell's stage IIIA or IIIB).

 Conclusion



In this prospective study, which included 998 preterm neonates, the incidence of feeding intolerance was 2.6%.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Fenton TR, Nasser R, Eliasziw M, Kim JH, Bilan D, Sauve R. Validating the weight gain of preterm infants between the reference growth curve of the fetus and the term infant. BMC Pediatr 2013;13:92.
2American Academy of Pediatrics (AAP). Breastfeeding and the use of human milk. Policy statement. J Pediatr 2012;129:e827-41.
3Moore TA, Wilson ME. Feeding intolerance: A concept analysis. Adv Neonatal Care 2011;11:149-54.
4Mansi Y, Abdelaziz N, Ezzeldin Z, Ibrahim R. Randomized controlled trial of a high dose of oral erythromycin for the treatment of feeding intolerance in preterm infants. Neonatology 2011;100:290-4.
5Indrio F, Riezzo G, Cavallo L, Di Mauro A, Francavilla R. Physiological basis of food intolerance in VLBW. J Matern Fetal Neonatal Med 2011;24 Suppl 1:64-6.
6Yoon JM, Park JY, Ko KO, Lim JW, Cheon EJ, Kim HJ. Fecal calprotectin concentration in neonatal necrotizing enterocolitis. Korean J Pediatr 2014;57:351-6.
7Ramani M, Ambalavanan N. Feeding practices and necrotizing enterocolitis. Clin Perinatol 2013;40:1-10.
8Zoppelli L, Güttel C, Bittrich HJ, Andrée C, Wirth S, Jenke A. Fecal calprotectin concentrations in premature infants have a lower limit and show postnatal and gestational age dependence. Neonatology 2012;102:68-74.
9Albanna EA, Ahmed HS, Awad HA. Stool calprotectin in necrotizing enterocolitis. J Clin Neonatol 2014;3:16-9.
10Carroll D, Corfield A, Spicer R, Cairns P. Faecal calprotectin concentrations and diagnosis of necrotising enterocolitis. Lancet 2003;361:310-1.
11Yang Q, Smith PB, Goldberg RN, Cotten CM. Dynamic change of fecal calprotectin in very low birth weight infants during the first month of life. Neonatology 2008;94:267-71.
12Aydemir G, Cekmez F, Tanju IA, Canpolat FE, Genc FA, Yildirim S, et al. Increased fecal calprotectin in preterm infants with necrotizing enterocolitis. Clin Lab 2012;58:841-4.