motilin and Infant--Premature--Diseases

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

To observe changes in plasma motilin (MOT) level among preterm infants after birth, to investigate the relationship between plasma motilin level and feeding intolerance (FI), and to clarify the possible risk factors.. A total of 112 preterm infants were divided into feeding tolerance (FT) group (n=59) and FI group (n=53). Their plasma MOT levels were measured by radioimmunoassay on days 1, 4, 7 and 14 of life. The clinical data of FI group were collected and subjected to multivariate logistic regression analysis.. Compared with the FT group, the FI group showed significantly lower plasma MOT levels on days 1, 4, 7 and 14 of life (P<0.05), and there was a positive correlation between plasma MOT level and gestational age, age in days, and volume of enteral feeding in the FI group. The lower the gestational age, the longer the FI duration. There was a negative correlation between the plasma MOT level on day 1 of life and the FI duration (r=-0.913, P<0.001). Gestational age and prenatal use of glucocorticoid were protective factors for FI, while fetal distress, placental abnormality and perinatal infection were risk factors for FI.. Change in plasma MOT level may be closely related to the development of FI in preterm infants. Early monitoring of plasma MOT level may be useful for predicting the occurrence of FI.

Topics: Enteral Nutrition; Female; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Logistic Models; Male; Motilin

In this prospective study, the 24-hour gastric aspirate volume was carefully recorded before, 24 and 48 h after administering 1.7 mg/kg/8-hourly of oral erythromycin to 16 ventilated neonates less than 32 weeks of gestation. Their median gestational age was 28.5 weeks (range 23-31 weeks), their median birthweight was 1,045 g (range 690-1,560 g) and the median day of life at which erythromycin was commenced was 9.5 days (range 4-16 days). Prior to administering erythromycin median 24-hour gastric aspirate volume, expressed as a percentage of the milk volume given over the same period, was 38.5% (range 20.0-100%). It was significantly lower 24 h (median 12%, range 0-41%, p = 0.0004) and 48 h (median 5%, range 0-21%, p = 0.0004) after commencing erythromycin. There was also significant reduction of gastric aspirate volume between 24 and 48 h after commencing erythromycin (p = 0.0024). Milk volume increment over the same period was not significant (p = 0.1022). These preliminary results warrant further evaluation through a randomised controlled trial.

Topics: Administration, Oral; Dose-Response Relationship, Drug; Enteral Nutrition; Erythromycin; Gastrointestinal Agents; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Motilin; Prospective Studies; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Stomach; Suction