The effect of drip versus intermittent feeding on splanchnic oxygenation in preterm infants with intrauterine growth restriction: a prospective randomized trial.

The main purpose of this study was to evaluate the impact of drip versus intermittent feeding on splanchnic oxygenation in preterm infants with intrauterine growth restriction. The second objective was to assess the relationship between fetal splanchnic circulation parameters and splanchnic oxygenation during the first week of life. A single-center, prospective, randomized study with 51 fetuses/infants was conducted. Fetal Doppler measurements including umbilical artery, middle cerebral artery, and superior mesenteric artery (SMA) were recorded in IUGR fetuses. After preterm delivery, the infants were randomly assigned to one of two feeding modalities: drip (3-h continuous) or intermittent (bolus in 10 min). Continuous regional splanchnic saturation (rSO2S) monitoring was carried out during the first week of life, simultaneously with continuous oxygen arterial saturation (SaO2) monitoring, and the infants' fractional oxygen extractions (FOE) were calculated. These parameters were evaluated as means on a daily basis for the first week of life, as well as pre-prandial and post-prandial measurements on the seventh day. Fetal Doppler flow velocimetry disturbances were present in 72.5% of the study cohort. The drip (26 infants) and intermittent (25 infants) groups were similar in demographic and clinical characteristics, as well as the prevalence of feeding intolerance and necrotizing enterocolitis. During the first week of life, there was no difference in daily mean rSO2S and FOE values between the drip and intermittent groups, whereas unfed infants had mostly lower rSO2S values. Pre-prandial and post-prandial rSO2S values remained stable in both groups. Also, no association was detected between fetal splanchnic circulation parameters and neonatal splanchnic oxygenation. RSO2S values were strongly correlated to gestational age and birth weight. During the whole week, except for the first 2 days, infants with umbilical catheters had significantly lower rSO2S values than infants without.  Conclusion: Our data suggest that the key factor in splanchnic oxygenation is feeding, not the feeding modality. In addition, the umbilical vein catheter had a negative impact on splanchnic oxygenation.  Clinical Trial Registration: The Effect of Neonatal Feeding Modalities on Splanchnic Oxygenation, NCT05513495,  https://clinicaltrials.gov/ct2/results cond=&term=NCT05513495&cntry=TR&state=&city=&dist= . Retrospectively registered, date of registration: August 2022. What is Known: • It is known that preterm infants with IUGR are at increased risk of hypoxic-ischemic intestinal damage and impaired splanchnic oxygenation. What is New: • The key factor in splanchnic oxygenation of preterm infants with IUGR is feeding, not the feeding modality (drip or intermittent). • In addition, the umbilical vein catheter had a negative impact on splanchnic oxygenation.

The Relationship of Breastfeeding Patterns in the Neonatal Intensive Care Unit to Maternal Symptoms of Anxiety and Depression.

Background: The studies related to psychiatric disorders have demonstrated high frequency of maternal stress, anxiety, and postpartum depression in mothers who have infants in neonatal intensive care unit (NICU). It is well known that maternal anxiety and depression adversely affect breastfeeding. The research aims to examine the association between the anxiety and depressive symptom severity of NICU mothers and feeding type (exclusively breastfed [EBF] or mixed fed [MF]) of their infants within first week of life in NICU. Methods: Data were collected from 93 mothers and 105 infants in a single-center, prospective, cross-sectional, descriptive study. The state-trait anxiety and depressive symptom severity of NICU mothers were evaluated using the Spielberger State-Trait Anxiety Inventory (STAI, including Spielberger State-Trait Anxiety Inventory-State [STAI-S], Spielberger State-Trait Anxiety Inventory-Trait [STAI-T]), and Edinburgh Postnatal Depression Scale (EPDS). Results: Breastfeeding exclusivity in NICU infants was significantly related to gestational age, birth weight, prenatal steroid, and assisted reproductive technology (ART; p = 0.022, 0.041, 0.028, 0.017, respectively). The comparison of STAI-S, STAI-T, and EPDS scores of NICU mothers between EBF and MF groups revealed that STAI-T score was significantly high in EBF group than that in the MF group (p = 0.019). Logistic regression analyses showed that a 1-unit increase in STAI-T score in NICU mothers was significantly associated with a 5.7% increase in the odds of breastfeeding exclusivity within first week in postpartum period (p = 0.033; odds ratio = 1.057, 95% confidence interval = 1.004-1.113). Conclusions: Contrary to estimates, clinically significant state and trait anxiety symptoms and depressive symptoms of NICU mothers do not affect breastfeeding exclusivity negatively within first week of life in NICU. Preterm infants under 32 gestational weeks and infants born with ART have a tendency to being EBF.