Enteral Administration of a Simulated Amniotic Fluid In Preventing Feeding Intolerance And Necrotizing Enterocolitis In Very Low Birth Weight Neonates

Abstract

Summary F eeding intolerance and necrotizing enterocolitis are key concerns with enteral nutrition in VLBW infants. Primary prevention of Feeding intolerance and NEC should be the priority, since NEC frequently progresses from nonspecific signs, to extensive necrosis within a matter of hours with medical or surgical treatment, making successful treatment and secondary prevention difficult to achieve. Fetal swallowing of amniotic fluid, which contains numerous cytokines and growth factors, plays a key role in gut mucosal development. Preterm birth interrupts this exposure to amniotic fluid-borne growth factors, possibly contributing to the increased risk of NEC in premature infants. The current study was a randomized controlled study conducted in NICU of maternity hospital of Ain Shams university in the period from 10/2013- 09/2014. It aimed to test the validity of a hypothesis suggesting that feeding intolerance and NEC could be prevented in VLBW neonates by enteral administration of a simulated amniotic fluid (SAFE) which contains rhG-CSF and rhEPO. Besides, achieving other benefits e.g. decreasing NPO days, decreasing the need for TPN to avoid its complications and cost and decrease hospital stay. Our study involved 40 VLBW neonates allocated equally and randomly in 2 groups. SAFE group contained 20 neonates received simulated amniotic fluid enterally. Placebo group contained 20 neonates received placebo. Exclusion criteria were major congenital anomalies, need for parenteral rEpo and/or rG-CSF, neonates admitted to our NICU after day 3 of life and parental refusal. We observed from our study thatSAFE was well tolerated enterally by the study group and no side effect as skin rash or changes in BP attributed to treatment were observed. Moreover, no effect on hemoglobin or WBCs. This makes enteral absorption of growth factors present in SAFE unlikely to occur. Our study revealed that the provision of SAFE did actually improve feeding tolerance in our population of study. After SAFE administration, SAFE group showed higher enteral caloric and volume intake and shorter duration to achieve full enteral feeding. From our study results we observed that overall mortality among VLBW neonates was 37.5% and mortality among VLBW neonates with NEC was 37.5%.