D Louis1, R Torgalkar1, J Shah1, P S Shah2, A Jain1. 1. Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada. 2. Department of Pediatrics and Health Policy, Management, and Evaluation, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
Abstract
OBJECTIVE: Enteral feeds are often discontinued or reduced during indomethacin treatment for patent ductus arteriosus (PDA) in preterm neonates, but the clinical impact of this practice is unknown. The objective of this study was to study the associations between enteral feed volume at the time of indomethacin therapy in preterm neonates with PDA and subsequent gastrointestinal outcomes. STUDY DESIGN: Retrospective cohort study. Single-center level III Neonatal Intensive Care Unit. RESULTS: All consecutive preterm neonates who had received treatment with indomethacin for PDA over a 5-year period were included and categorized based on enteral feed volume exposure during treatment (Group A: nil per oral (NPO, N=229); Group B: ⩽60 ml kg(-1) day(-1) (N=142); Group C:>60 ml kg(-1) day(-1) (N=44)). Baseline characteristics and clinical outcomes were compared between the three groups. The primary outcome was necrotizing enterocolitis (NEC) ⩾stage IIa, while secondary outcomes included other gastrointestinal complications and common prematurity-related morbidities. Group C had a higher gestational age (mean±s.d.; A: 26.3±1.8; B: 26.1±1.8; C: 27.0±2.0 weeks), birth weight (A: 864±239; B: 847±202; C: 932±234 g) and postnatal age at the time of indomethacin treatment (A: 5.3±2.9; B: 7.2±4.9; C: 15.4±6.6 days). All groups had similar rates of the primary outcome NEC (A: 6.1%, B: 7.8% and C: 4.6%, respectively). They also had similar rates of the secondary outcomes with the exception of days to reach enteral feeds of 120 ml kg(-1) day(-1) (A: 22.8±8.5; B: 20.5±8.6; C: 16.8±7.7; P<0.05 for all inter-group comparisons). Secondary analysis including only those neonates who were not already NPO before indomethacin treatment (N=261) and categorized based on preemptive management (made NPO; enteral feed volume reduced; enteral feed volume unchanged/increased) also showed similar results. CONCLUSIONS: This large retrospective study did not identify any association between enteral feed volumes during indomethacin treatment or preemptive reduction in enteral feeds and subsequent incidence of adverse gastrointestinal outcomes in preterm neonates. Preemptive reduction in enteral feed volume was associated with longer time to reach full enteral feeds.
OBJECTIVE: Enteral feeds are often discontinued or reduced during indomethacin treatment for patent ductus arteriosus (PDA) in preterm neonates, but the clinical impact of this practice is unknown. The objective of this study was to study the associations between enteral feed volume at the time of indomethacin therapy in preterm neonates with PDA and subsequent gastrointestinal outcomes. STUDY DESIGN: Retrospective cohort study. Single-center level III Neonatal Intensive Care Unit. RESULTS: All consecutive preterm neonates who had received treatment with indomethacin for PDA over a 5-year period were included and categorized based on enteral feed volume exposure during treatment (Group A: nil per oral (NPO, N=229); Group B: ⩽60 ml kg(-1) day(-1) (N=142); Group C:>60 ml kg(-1) day(-1) (N=44)). Baseline characteristics and clinical outcomes were compared between the three groups. The primary outcome was necrotizing enterocolitis (NEC) ⩾stage IIa, while secondary outcomes included other gastrointestinal complications and common prematurity-related morbidities. Group C had a higher gestational age (mean±s.d.; A: 26.3±1.8; B: 26.1±1.8; C: 27.0±2.0 weeks), birth weight (A: 864±239; B: 847±202; C: 932±234 g) and postnatal age at the time of indomethacin treatment (A: 5.3±2.9; B: 7.2±4.9; C: 15.4±6.6 days). All groups had similar rates of the primary outcome NEC (A: 6.1%, B: 7.8% and C: 4.6%, respectively). They also had similar rates of the secondary outcomes with the exception of days to reach enteral feeds of 120 ml kg(-1) day(-1) (A: 22.8±8.5; B: 20.5±8.6; C: 16.8±7.7; P<0.05 for all inter-group comparisons). Secondary analysis including only those neonates who were not already NPO before indomethacin treatment (N=261) and categorized based on preemptive management (made NPO; enteral feed volume reduced; enteral feed volume unchanged/increased) also showed similar results. CONCLUSIONS: This large retrospective study did not identify any association between enteral feed volumes during indomethacin treatment or preemptive reduction in enteral feeds and subsequent incidence of adverse gastrointestinal outcomes in preterm neonates. Preemptive reduction in enteral feed volume was associated with longer time to reach full enteral feeds.
Authors: Toby Debra Yanowitz; Jeff Reese; Maria Gillam-Krakauer; Caitlin M Cochran; Priya Jegatheesan; John Lau; Vy Thao Tran; Michele Walsh; William A Carey; Alan Fujii; Anthony Fabio; Ronald Clyman Journal: J Pediatr Date: 2013-12-08 Impact factor: 4.406
Authors: Ronald Clyman; Andrea Wickremasinghe; Nami Jhaveri; Denise C Hassinger; Joshua T Attridge; Ulana Sanocka; Richard Polin; Maria Gillam-Krakauer; Jeff Reese; Mark Mammel; Robert Couser; Neil Mulrooney; Toby D Yanowitz; Matthew Derrick; Priya Jegatheesan; Michele Walsh; Alan Fujii; Nicolas Porta; William A Carey; Jonathan R Swanson Journal: J Pediatr Date: 2013-03-06 Impact factor: 4.406
Authors: John Kelleher; Ariel A Salas; Ramachandra Bhat; Namasivayam Ambalavanan; Shampa Saha; Barbara J Stoll; Edward F Bell; Michele C Walsh; Abbot R Laptook; Pablo J Sánchez; Seetha Shankaran; Krisa P VanMeurs; Ellen C Hale; Nancy S Newman; M Bethany Ball; Abhik Das; Rosemary D Higgins; Myriam Peralta-Carcelen; Waldemar A Carlo Journal: Pediatrics Date: 2014-10-27 Impact factor: 7.124