title: Feeding issues in IUGR preterm infants.
abstract: Intra-uterine growth restriction (IUGR) is a severe and quite common problem in obstetrics. A condition of placental dysfunction can lead to a cardiovascular adaptation in the fetus characterized by a redistribution of cardiac output to maintain oxygen supply to the heart, adrenal glands and brain - the so-called brain sparing effect - at the expense of visceral organs (such as the gastrointestinal system). This condition may predispose IUGR infants to impaired gut function after birth. A higher incidence of necrotizing enterocolitis (NEC) is documented in IUGR preterm infants. Therefore, a common practice in neonatal intensive care units is to delay feeds to reduce the risk of feeding intolerance. Recent trials, however, have shown that early enteral feeding in IUGR infants is safe and it would appear, on the basis of the few available data, that breast milk could offer protection against NEC. This mini-review offers an update on feeding in IUGR infants. Future perspectives on the usefulness of Doppler and regional splanchnic and cerebral saturation monitoring for deciding when to start feeding are also provided.
authors.affiliation: Neonatal Intensive Care Unit, MBBM Foundation, San Gerardo Hospital, Monza, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Bozzetti
authors.forename: Paolo E
authors.initials: PE
authors.lastname: Tagliabue
authors.forename: Gerard H A
authors.initials: GH
authors.lastname: Visser
authors.forename: Frank
authors.initials: F
authors.lastname: van Bel
authors.forename: Diego
authors.initials: D
authors.lastname: Gazzolo
mesh_terms: D004750:Enteral Nutrition; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005317:Fetal Growth Retardation; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000517:prevention & control*; D007236:Infant, Small for Gestational Age / Q000502:physiology*; D007363:Intensive Care Units, Neonatal; D008895:Milk, Human; D010288:Parenteral Nutrition; D011247:Pregnancy
keywords: ACOG; AGA; ARED; American College of Obstetricians and Gynecologists; BS; BW; Brain sparing; FEF; Feeding tolerance; IUGR; MCA; MEF; NEC; NICU; NIRS; Necrotizing enterocolitis; PI; SGA; TPN; U/C; UA; VLBW; absent/reverse end-diastolic flow; adequate for gestational; birth weight; brain sparing; cerebroplacental ratio; full enteral feeding; intra-uterine growth restriction; middle cerebral artery; minimal enteral feeding; near infrared spectroscopy; necrotizing enterocolitis; neonatal intensive care unit; pulsatility index; small for gestational age; total parenteral nutrition; umbilical artery; very low birth weight