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12 - Enteral nutrition

Published online by Cambridge University Press:  05 August 2012

David H. Adamkin
Affiliation:
University of Louisville Medical Center
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Summary

“NECiphobia” (the fear of NEC) is the most prevalent reason clinicians withhold enteral feedings in VLBW infants. NEC most frequently occurs in VLBW infants who have received enteral nutrition. When parenteral nutrition is used exclusively for the provision of nutrients, the absence of enteral feedings is associated with morphologic and functional changes in the gut with a significant decrease in intestinal mass, a decrease in mucosal enzyme activity, and an increase in gut permeability. The changes are due primarily to the lack of luminal nutrients rather than the TPN. Therefore, parenteral nutrition does little to support the function of the gastrointestinal tract. The timing of the initial feedings for the preterm infant remains controversial. As pediatric TPN solutions designed for neonates became available, many clinicians chose to use parenteral nutrition exclusively in the sick, ventilated, preterm infant because of concerns about necrotizing enterocolitis. Total parenteral nutrition was thought to be a logical continuation of the transplacental nutrition the infants received in utero. However, this view discounts any role that swallowed amniotic fluid may play in nutrition and in the development of the gastrointestinal tract. In fact, by the end of the third trimester, the amniotic fluid provides the fetus with the same enteral volume intake and approximately 25% of the enteral protein intake as that of a term, breastfed infant. Studies in animals maintained in an anabolic state with TPN, but deprived of enteral substrate, confirmed that intraluminal nutrition was necessary for the development of normal gastrointestinal structure and functional integrity. Enteral feedings have both direct trophic effects and indirect effects secondary to the release of intestinal hormones.

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Publisher: Cambridge University Press
Print publication year: 2009

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  • Enteral nutrition
  • David H. Adamkin
  • Book: Nutritional Strategies for the Very Low Birthweight Infant
  • Online publication: 05 August 2012
  • Chapter DOI: https://doi.org/10.1017/CBO9780511605444.014
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  • Enteral nutrition
  • David H. Adamkin
  • Book: Nutritional Strategies for the Very Low Birthweight Infant
  • Online publication: 05 August 2012
  • Chapter DOI: https://doi.org/10.1017/CBO9780511605444.014
Available formats
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Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Enteral nutrition
  • David H. Adamkin
  • Book: Nutritional Strategies for the Very Low Birthweight Infant
  • Online publication: 05 August 2012
  • Chapter DOI: https://doi.org/10.1017/CBO9780511605444.014
Available formats
×