Necrotizing Enterocolitis, Premature
Conditions
Keywords
intestinal perfusion, postprandial intestinal perfusion, Color Doppler abdominal ultrasound
Brief summary
This is a pilot exploratory observational prospective cohort phase I study. In this study, we will gather preliminary data to evaluate (i) the magnitude of changes in blood flow in the bowel before and after feeding and (ii) the differences between preterm and term infants.
Detailed description
Necrotizing enterocolitis (NEC) is the most devastating intestinal disease which remains a major unsolved clinical challenge in neonatology. NEC is predominantly a disease of preterm or extremely preterm infants. NEC results in high mortality, neurodevelopmental impairment, intestinal failure, and reduced quality of life. Prematurity and enteral feeding are two of the most important risk factors for NEC. More than 90% of infants with NEC have been enterally fed, suggesting that feeding is an important priming step in making the intestine vulnerable to NEC. Absorption of nutrients is energy-consuming and results in an increased oxygen demand after feeding, followed by an increase in intestinal blood flow above baseline (known as postprandial hyperemia). Our preclinical studies have shown an intriguing discovery, that prematurity is associated with a remarkably reduced intestinal response to feeding, which predisposes the intestine to NEC. However, there is lack of reliable clinical evidence to compare the magnitude of difference in postprandial intestinal blood flow in human preterm versus term infants. If preterm infants do in fact demonstrate a diminished intestinal blood flow response to feeding, this will shed light on the need for interventions in the feeding protocol of this vulnerable population to prevent the development of NEC. This study is a phase I exploratory prospective cohort study. We will gather preliminary data to evaluate (i) the magnitude of changes in blood flow in the bowel before and after feeding and (ii) the differences between preterm and term infants. In a cohort of 20 patients (10 preterm, 10 term), we will evaluate feeding-related perfusion of the superior mesenteric artery and bowel wall immediately before and 60-minutes after feeding.
Interventions
OTHEREvaluation of intestinal perfusion with color Doppler abdominal ultrasound before and after feeding.
This is an observation study involving measurement of intestinal perfusion with color Doppler abdominal ultrasound before and after feeding. No intervention is given to study participants.
Sponsors
Xiamen Children's Hospital
The Hospital for Sick Children
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
No minimum to 4 Weeks
Healthy volunteers
Yes
Inclusion criteria
* Preterm infants (≤33 weeks gestational age) of any birth weight receiving full bolus enteral feeding.
Exclusion criteria
* Neonates receiving bolus enteral feeds lasting \>30 minutes or continuous enteral feeds will be excluded to avoid overlapping or close timing between pre- and post-prandial intestinal perfusion measurements. * Large patent ductus arteriosus (PDA) * Major congenital malformations * Suspected genetic syndrome * Ssuspected or confirmed infection * Fraction of inspired oxygen of ≥0.60 at enrollment * Confirmed diagnosis of necrotizing enterocolitis diagnosis. NEC will be diagnosed when at least two of the following clinical signs and one radiological sign will be present: (i) Clinical signs (1. abdominal distension; 2. abdominal tenderness; 3. abdominal discoloration; 4. blood in stool). (ii) Radiological signs (1. Pneumoperitoneum; 2. pneumatosis; 3. portal venous gas).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time-averaged mean velocity of the superior mesenteric artery | Measured immediately before and 60 minutes after feeding | Abdominal ultrasound is used to measure the percent change in time-averaged mean velocity (TAMV) of the superior mesenteric artery (SMA) between pre and post-prandial assessments. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Bowel wall perfusion | Measured immediately before and 60 minutes after feeding | Color Doppler abdominal ultrasound is used to measure changes in peripheral perfusion of the bowel wall pre- and post-prandially. |
Countries
China
Contacts
Primary ContactAgostino Pierro, OBE, MD, FRCS, FAAP
Backup ContactNiloofar Ganji, BSc, MSc
Outcome results
None listed