Abstract：
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.
摘要：
这项研究的主要目的是评估滴注与间歇喂养对宫内生长受限早产儿内脏氧合的影响。第二个目标是评估出生后第一周胎儿内脏循环参数与内脏氧合之间的关系。单中心,prospective,我们对51例胎儿/婴儿进行了随机研究.胎儿多普勒测量包括脐动脉，大脑中动脉,在IUGR胎儿中记录肠系膜上动脉（SMA）。早产后,婴儿被随机分配到两种喂养方式之一:滴注(3小时连续)或间歇(10分钟内推注).在生命的第一周进行了连续的区域内脏饱和度（rSO2S）监测，同时进行连续氧动脉饱和度（SaO2）监测，并计算了婴儿的氧气提取分数（FOE）。这些参数被评估为生命第一周的每日平均值，以及第七天的餐前和餐后测量。72.5％的研究队列中存在胎儿多普勒血流测速障碍。滴注（26例婴儿）和间歇（25例婴儿）组的人口统计学和临床特征相似，以及喂养不耐受和坏死性小肠结肠炎的患病率。在生命的第一周，滴注组和间歇组之间的每日平均rSO2S和FOE值没有差异，而未喂养婴儿的rSO2S值大多较低。两组餐前和餐后rSO2S值保持稳定。此外，未检测到胎儿内脏循环参数与新生儿内脏氧合之间的相关性.RSO2S值与胎龄和出生体重密切相关。整个星期,除了前两天，有脐导管的婴儿rSO2S值显著低于无脐导管的婴儿.结论：我们的数据表明内脏氧合的关键因素是进食，不是喂养方式。此外,脐静脉导管对内脏氧合有负面影响.临床试验注册：新生儿喂养方式对内脏氧合的影响，NCT05513495，https://clinicaltrials.gov/ct2/resultscond=&term=NCT05513495&cntry=TR&state=&city=&dist=。追溯登记,注册日期：2022年8月。已知:•已知患有IUGR的早产儿处于缺氧缺血性肠损伤和内脏氧合受损的增加的风险。新增内容：•IUGR早产儿内脏氧合的关键因素是喂养，不是喂养方式(滴注或间歇)。此外，脐静脉导管对内脏氧合有负面影响.
