motilin and Enterocolitis--Necrotizing

Gut hormones play an important role in the adaptation of the immature neonatal gut, and their secretion may be modulated by prebiotics. Furthermore, prebiotics are well known for their hypolipidemic potentials. We tested the hypothesis that prebiotics could alter motilin and gastrin secretion and reduce lipids in healthy preterms.. A total of 167 newborns were randomized to either a prebiotics enriched formula containing dietary oligosaccharides (short-chain galacto-oligo-saccharides/long-chain fructo-oligo-saccharides [scGOS/lcFOS]), at a concentration of 0.8 g/100 ml, or a common preterm formula. Day 1 and 16 basal motilin, gastrin concentrations, and lipids were evaluated together with growth parameters, gastric residue, bowel habits, and feeding tolerance. Adverse events including necrotizing enterocolitis (NEC) and septicemia were also recorded.. Mean motilin increase and day 16 mean values were greater for the intervention, compared with the control group (P = .001, P = .005, respectively), while gastrin remained high in both groups. Mean cholesterol and low density lipoprotein (LDL) increase were significantly greater in the control, compared with the intervention (P = .037, and P = .001) group. Day 16 LDL levels were significantly higher in the control group. Mean weight was increased in the control group, while gastric residue was less and stool frequency was increased in the intervention group. NEC and septicemia were not statistically different between groups.. A prebiotics enriched formula resulted in significant surge of motilin relating to reduced gastric residue, compared with a common preterm formula. Mean cholesterol change was lower, while LDL was not increased in the prebiotics group, compared with the control group.

Topics: Adult; Body Weight; Cholesterol; Cholesterol, LDL; Defecation; Double-Blind Method; Enterocolitis, Necrotizing; Feces; Female; Gastric Emptying; Gastrins; Gastrointestinal Tract; Growth; Humans; Incidence; Infant Formula; Infant, Newborn; Infant, Premature; Motilin; Oligosaccharides; Prebiotics; Pregnancy; Sepsis; Young Adult

Approximately 90% of infants who develop necrotizing enterocolitis (NEC) do so after being fed. Previous prospective studies have shown that infants given small enteral feedings for the first 7 to 10 days of feeding do not have an increased risk for NEC compared with those given no feedings. Although neonatologists now commonly increase feeding volumes, no study has compared the risk for NEC between infants fed these small volumes and those fed volumes that are increased slowly. The purpose of this study was to compare the risks and benefits of small and increasing feeding volume.. In a randomized, controlled trial, we randomly assigned 141 preterm infants in the newborn intensive care unit to be fed 10 days using 1 of 2 schedules. One group was fed 20 mL/kg/d for the first 10 study days (minimal). The other group (advancing) was fed 20 mL/kg/d on study day 1; feeding volume was increased by 20 mL/kg/d up to 140 mL/kg/d, which was maintained until study day 10. The main outcome measure was incidence of NEC; secondary outcomes were maturation of intestinal motor patterns, time to reach full enteral feedings, and incidence of late sepsis.. The study was closed early because 7 infants who were assigned to advancing feeding volumes developed NEC, whereas only 1 infant fed minimal feeding volumes did, or 10% versus 1.4%. Although infants who were fed minimal volumes established full enteral feeding volumes later than infants who were fed advancing volumes, maturation of intestinal motor patterns and the incidence of late sepsis and feeding intolerance was similar in the 2 groups.. Given that advancing feeding volumes increase the risk of NEC without providing benefits for motor function or feeding tolerance, neonatologists should consider using minimal feeding volumes until future trials assess the safety of advancing feeding volumes.

Topics: Enteral Nutrition; Enterocolitis, Necrotizing; Feeding Behavior; Gastrins; Gastrointestinal Motility; Humans; Incidence; Infant Food; Infant, Newborn; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Intensive Care Units, Neonatal; Motilin; Neonatology; Peristalsis; Retrospective Studies; Risk Assessment