title: Enteral feeding during indomethacin and ibuprofen treatment of a patent ductus arteriosus.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, University of California San Francisco, San Francisco, CA 94143-0544, USA. clymanr@peds.ucsf.edu
authors.forename: Ronald
authors.initials: R
authors.lastname: Clyman
authors.forename: Andrea
authors.initials: A
authors.lastname: Wickremasinghe
authors.forename: Nami
authors.initials: N
authors.lastname: Jhaveri
authors.forename: Denise C
authors.initials: DC
authors.lastname: Hassinger
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Attridge
authors.forename: Ulana
authors.initials: U
authors.lastname: Sanocka
authors.forename: Richard
authors.initials: R
authors.lastname: Polin
authors.forename: Maria
authors.initials: M
authors.lastname: Gillam-Krakauer
authors.forename: Jeff
authors.initials: J
authors.lastname: Reese
authors.forename: Mark
authors.initials: M
authors.lastname: Mammel
authors.forename: Robert
authors.initials: R
authors.lastname: Couser
authors.forename: Neil
authors.initials: N
authors.lastname: Mulrooney
authors.forename: Toby D
authors.initials: TD
authors.lastname: Yanowitz
authors.forename: Matthew
authors.initials: M
authors.lastname: Derrick
authors.forename: Priya
authors.initials: P
authors.lastname: Jegatheesan
authors.forename: Michele
authors.initials: M
authors.lastname: Walsh
authors.forename: Alan
authors.initials: A
authors.lastname: Fujii
authors.forename: Nicolas
authors.initials: N
authors.lastname: Porta
authors.forename: William A
authors.initials: WA
authors.lastname: Carey
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Swanson
mesh_terms: D003131:Combined Modality Therapy; D004374:Ductus Arteriosus, Patent / Q000188:drug therapy / Q000628:therapy*; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use*; D007213:Indomethacin / Q000627:therapeutic use*; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D007052:Ibuprofen; D007213:Indomethacin
keywords: BPD; Bronchopulmonary dysplasia; NEC; Necrotizing enterocolitis; Nil per os; PDA; Patent ductus arteriosus; npo