Gastrointestinal Problems and Early Enteral Feeding in Mechanically Ventilated Preterm Infants

ABSTRACT

Extremely low birth weight (ELBW) infants in neonatal intensive care units often receive overriding attention to their acute respiratory illness that appropriate attention to certain other "adjunctive" needs, like adequate nutrition, is often delayed. Clinical reluctance to attempt this enterally includes concerns involving immaturity of gastrointestinal tract, severe medical problems like respiratory distress syndrome (RDS) with the need for assisted ventilation, and fear of necrotizing entrocolitis (NEC). As a consequence, ill newborns may experience periods of moderate to severe under-nutrition during the most acute phase of their respiratory problems. We are now at a juncture where the optimal time to begin enteral feedings in our smallest and sickest preterm infants is being re- evaluated. The practical aspects of how to proceed in providing ideal energy, protein, and specific nutrients for these infants are not easy. The purpose of this article is to review and scrutinize nutritional decisions that need to be made in these critically ill neonates on assisted ventilation. In the first part of this article, Enteral Nutrition such as minimal enteral feeding (MEF), osmolarity, choice of milk, methods of delivery, when to start, etc. will be discussed. In the second part of this article, gastrointestinal (GI) problem such as GI motility, gastroesophageal reflux (GER), tracheal aspiration, gastric hemorrhage or perforation, necrotizing enterocolitis, etc. will be discussed. Though many physiologic studies have supported MEF in preterm infants, clinical studies have not sufficiently addressed the questions of "How early?" "How much?" "For how long?". But most enteral feeding in preterm infants, especially ventilated ELBW infant, must be individualized.