Does chronic prenatal Doppler pathology predict feeding difficulties in neonates?

AIM: To determine whether infants with compromised fetomaternal circulation, but not yet critically threatened by absent end-diastolic flow velocities in the umbilical arteries, are at a risk for feeding problems.

METHODS

In a retrospective case-control study, enteral feeding and clinical data were compared between infants with decreased prenatal end-diastolic umbilical flow velocity (DEDFV) or brain-sparing pathology and controls matched for gestational age (GA). In all infants, enteral feedings were advanced according to a standardized enteral feeding protocol.

RESULTS

11 (GA>34 wk) of the 87 infants with DEDFV were fully enterally fed by day 5 and excluded, leaving 76 infants (and matched controls) for final analysis. DEDFV infants were significantly smaller (1,230+/-550 g vs 1,600+/-682 g). Advancement of enteral feedings varied widely, with a significant difference between DEDFV infants and controls. There was no difference in the incidence of NEC (five in both groups). In the most severely affected subgroup of 25 infants with GA<30 wk and prenatal brain sparing, enteral feedings were significantly delayed in comparison to the controls (parenteral amino acid administration for 22 vs 15 d; significantly fewer enteral calories through day 15).

CONCLUSION

Enteral feeds were introduced more slowly to infants who had shown signs of prenatal distress with brain sparing. However, a predisposition to NEC could not be proven. Our results thus do not support the delay of enteral feedings based on prenatal Doppler pathology.