title: Randomized controlled trial of early enteral fat supplement and fish oil to promote intestinal adaptation in premature infants with an enterostomy.
abstract: OBJECTIVE
  To test the hypothesis that early enteral supplementing fat and fish oil decreases the duration of parenteral nutrition (PN) and increases enteral nutrition (EN) before bowel reanastomosis in premature infants with an enterostomy.
  
  
  METHODS
  Premature infants (<2 months old) who had an enterostomy and tolerated enteral feeding at 20 mL/kg/day were randomized to usual care (control=18) or early supplementing enteral fat supplement and fish oil (treatment=18). Intravenous lipid was decreased as enteral fat intake was increased. Daily weight, clinical and nutrition data, and weekly length and head circumference were recorded. The primary outcomes were the duration of PN and volume of EN intake, and the secondary outcomes were weight gain (g/day), ostomy output (mL/kg/d), and serum conjugated bilirubin level (mg/dL) from initiating feeding to reanastomosis. Data were analyzed by Student t test or Wilcoxon rank sum test.
  
  
  RESULTS
  There were no differences in the duration of PN, ostomy output, and weight gain between the 2 groups before reanastomosis. However, supplemented infants received less intravenous lipid, had greater EN intake, and lower conjugated bilirubin before reanastomosis, and they also received greater total calorie, had fewer sepsis evaluations and less exposure to antibiotics and central venous catheters before reanastomosis, and had greater weight and length gain after reanastomosis (all P<.05).
  
  
  CONCLUSIONS
  Early enteral feeding of a fat supplement and fish oil was associated with decreased exposure to intravenous lipid, increased EN intake, and reduced conjugated bilirubin before reanastomosis and improved weight and length gain after reanastomosis in premature infants with an enterostomy.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Wake Forest University Health Science, Winston-Salem, NC. Electronic address: qyang@wakehealth.edu.
authors.forename: Qing
authors.initials: Q
authors.lastname: Yang
authors.affiliation: Clinical Nutrition Department, Wake Forest University Health Science, Winston-Salem, NC.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Ayers
authors.affiliation: Division of Neonatology, Department of Pediatrics, Wake Forest University Health Science, Winston-Salem, NC.
authors.forename: Cherrie D
authors.initials: CD
authors.lastname: Welch
authors.affiliation: Division of Neonatology, Department of Pediatrics, Wake Forest University Health Science, Winston-Salem, NC.
authors.forename: T Michael
authors.initials: TM
authors.lastname: O'Shea
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology*; D004042:Dietary Fats, Unsaturated / Q000008:administration & dosage*; D019587:Dietary Supplements; D004750:Enteral Nutrition / Q000379:methods; D004766:Enterostomy; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage*; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007408:Intestinal Absorption / Q000502:physiology*; D007422:Intestines / Q000503:physiopathology*; D008297:Male; D010288:Parenteral Nutrition / Q000379:methods
chemical_list: D004042:Dietary Fats, Unsaturated; D005217:Fat Emulsions, Intravenous; D005395:Fish Oils