Enteral feeding during indomethacin and ibuprofen treatment of a patent ductus arteriosus
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, Ductus Arteriosus Feed or Fast with Indomethacin or Ibuprofen (DAFFII) Investigators, Ronald Clyman, Andrea Wickremasinghe, Nami Jhaveri, Scott Fields, Jeffrey Fineman, Yao Sun, Philip Moore, Denise C Hassinger, Jonathan R Swanson, Caryn Peters, Joshua T Attridge, Amy E Blackman, Jonathan R Swanson, Richard Polin, Ulana Sanocka, Teresa Bowman, Erin Amadori, Glen Bona, Marilyn Weindler, Jeff Reese, Maria Gillam-Krakauer, Amy Law-Beller, Mark Mammel, Patricia Meyers, Robert Couser, Neil Mulrooney, Molly Maxwell, Cathy Worwa, Toby D Yanowitz, Robyn Baker, Matthew Derrick, Priya Jegatheesan, Brian Scottoline, Dongli Song, Michele Walsh, Jalal Abu-Shaweesh, Bonnie Siner, Joyce Gallagher, Nancy Newman, Alan Fujii, Nicolas Porta, Marissa deUngria, Malika Shah, Karin Hamann, William A Carey, Gretchen A Voge, 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, Ductus Arteriosus Feed or Fast with Indomethacin or Ibuprofen (DAFFII) Investigators, Ronald Clyman, Andrea Wickremasinghe, Nami Jhaveri, Scott Fields, Jeffrey Fineman, Yao Sun, Philip Moore, Denise C Hassinger, Jonathan R Swanson, Caryn Peters, Joshua T Attridge, Amy E Blackman, Jonathan R Swanson, Richard Polin, Ulana Sanocka, Teresa Bowman, Erin Amadori, Glen Bona, Marilyn Weindler, Jeff Reese, Maria Gillam-Krakauer, Amy Law-Beller, Mark Mammel, Patricia Meyers, Robert Couser, Neil Mulrooney, Molly Maxwell, Cathy Worwa, Toby D Yanowitz, Robyn Baker, Matthew Derrick, Priya Jegatheesan, Brian Scottoline, Dongli Song, Michele Walsh, Jalal Abu-Shaweesh, Bonnie Siner, Joyce Gallagher, Nancy Newman, Alan Fujii, Nicolas Porta, Marissa deUngria, Malika Shah, Karin Hamann, William A Carey, Gretchen A Voge
Abstract
Objective: To test the hypothesis that infants who are just being introduced to enteral feedings will advance to full enteral nutrition at a faster rate if they receive "trophic" (15 mL/kg/d) enteral feedings while receiving indomethacin or ibuprofen treatment for patent ductus arteriosus.
Study design: Infants were eligible for the study if they were 23(1/7)-30(6/7) weeks' gestation, weighed 401-1250 g at birth, received maximum enteral volumes ≤60 mL/kg/d, and were about to be treated with indomethacin or ibuprofen. A standardized "feeding advance regimen" and guidelines for managing feeding intolerance were followed at each site (N = 13).
Results: Infants (N = 177, 26.3 ± 1.9 weeks' mean ± SD gestation) were randomized at 6.5 ± 3.9 days to receive "trophic" feeds ("feeding" group, n = 81: indomethacin 80%, ibuprofen 20%) or no feeds ("fasting [nil per os]" group, n = 96: indomethacin 75%, ibuprofen 25%) during the drug administration period. Maximum daily enteral volumes before study entry were 14 ± 15 mL/kg/d. After drug treatment, infants randomized to the "feeding" arm required fewer days to reach the study's feeding volume end point (120 mL/kg/d). Although the enteral feeding end point was reached at an earlier postnatal age, the age at which central venous lines were removed did not differ between the 2 groups. There were no differences between the 2 groups in the incidence of infection, necrotizing enterocolitis, spontaneous intestinal perforation, or other neonatal morbidities.
Conclusion: Infants required less time to reach the feeding volume end point if they were given "trophic" enteral feedings when they received indomethacin or ibuprofen treatments.
Trial registration: ClinicalTrials.gov NCT00728117.
Keywords: BPD; Bronchopulmonary dysplasia; NEC; Necrotizing enterocolitis; Nil per os; PDA; Patent ductus arteriosus; npo.
Conflict of interest statement
The authors declare no conflicts of interest.
Copyright © 2013 Mosby, Inc. All rights reserved.
Source: PubMed