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Research article
Elena Maggiora
Universita degli Studi di Torino Dipartimento di Scienze della Sanità Pubblica e Pediatriche
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7491-468X
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Background : Feeding intolerance, defined as the inability to digest enteral feeding, is a frequent diagnosis in very preterm infants. It is characterized by abdominal distension, delayed gastric emptying and increased frequency and severity of gastroesophageal reflux (GER). As seen in the FortiLat trial, human milk fortification with the new donkey milk-derived human milk fortifier (DF) seems to improve feeding tolerance in these infants. The aim of this ancillary study of the FortiLat trial was to evaluate the effects of using the DF compared with bovine milk-derived fortifier (BF) on GER in VLBW infants.
Methods : Over a total of 156 preterm infants enrolled into the FortiLat trial (gestational age <32 weeks and/or birth weight <1500 g) and randomized into BF-arm or DF-arm we selected all infants with clinical signs of GER and cardiorespiratory (CR) symptoms at day 21 of fortification. All the infants underwent CR and multichannel intraluminal impedance and pH (MII/pH) monitoring associated with gastric ultrasound to evaluate GER characteristics, GER-CR temporal associations and gastric emptying time.
Results : 10 infants were enrolled, 5 in the DF-arm. At MII/pH infants enrolled into the DF-arm showed a lower GER frequency than BF-arm infants: 2.02(1.95-3.26) vs 4.82(2.84-5.94) GER/hour (p=0.036). No infant had a significant symptom association probability index between GER and CR events. Half gastric emptying time was similar in DF and BF-arm infants: 45.03(42.74-47.02) vs. 48.57(44.73-48.77) min. (p=0.744)
Conclusions : The use of donkey derived human milk fortifier reduced the GER frequency and consequently should be recommended in infants with feeding intolerance.
Trial Registration : ISRCTN -ISRCTN70022881. Registered 01May 2014 - Retrospectively registered, http://www.isrctn.com/ISRCTN70022881
Keywords
VLBW, GORD, very preterm, feeding intolerance, tolerance, cardiorespiratory events, MII/pH
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This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research article
Elena Maggiora
Universita degli Studi di Torino Dipartimento di Scienze della Sanità Pubblica e Pediatriche
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7491-468X
Badges
Prescreen
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Complete author information
Appropriate declaration statements
Potential risks to human health
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History
CURRENT STATUS: Posted
View the published article at Nutrients.
Version 1
Posted 07 Apr, 2020
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Nutrition & Dietetics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Nutrients.
Background : Feeding intolerance, defined as the inability to digest enteral feeding, is a frequent diagnosis in very preterm infants. It is characterized by abdominal distension, delayed gastric emptying and increased frequency and severity of gastroesophageal reflux (GER). As seen in the FortiLat trial, human milk fortification with the new donkey milk-derived human milk fortifier (DF) seems to improve feeding tolerance in these infants. The aim of this ancillary study of the FortiLat trial was to evaluate the effects of using the DF compared with bovine milk-derived fortifier (BF) on GER in VLBW infants.
Methods : Over a total of 156 preterm infants enrolled into the FortiLat trial (gestational age <32 weeks and/or birth weight <1500 g) and randomized into BF-arm or DF-arm we selected all infants with clinical signs of GER and cardiorespiratory (CR) symptoms at day 21 of fortification. All the infants underwent CR and multichannel intraluminal impedance and pH (MII/pH) monitoring associated with gastric ultrasound to evaluate GER characteristics, GER-CR temporal associations and gastric emptying time.
Results : 10 infants were enrolled, 5 in the DF-arm. At MII/pH infants enrolled into the DF-arm showed a lower GER frequency than BF-arm infants: 2.02(1.95-3.26) vs 4.82(2.84-5.94) GER/hour (p=0.036). No infant had a significant symptom association probability index between GER and CR events. Half gastric emptying time was similar in DF and BF-arm infants: 45.03(42.74-47.02) vs. 48.57(44.73-48.77) min. (p=0.744)
Conclusions : The use of donkey derived human milk fortifier reduced the GER frequency and consequently should be recommended in infants with feeding intolerance.
Trial Registration : ISRCTN -ISRCTN70022881. Registered 01May 2014 - Retrospectively registered, http://www.isrctn.com/ISRCTN70022881
Figure 1
This is a list of supplementary files associated with this preprint. Click to download.
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