title: Late Enteral Feedings Are Associated with Intestinal Inflammation and Adverse Neonatal Outcomes.
abstract: BACKGROUND
  Morbidities of impaired immunity and dysregulated inflammation are common in preterm infants. Postnatal Intestinal development plays a critical role in the maturation of the immune system and is, in part, driven by exposure to an enteral diet.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the influence of the timing of the first enteral feeding on intestinal inflammation and risk of disease.
  
  
  METHODS
  130 infants <33 weeks' gestation were studied. Maternal and infant data were abstracted from the medical record. Single and multiplex ELISA assays quantified cytokines from fecal and serum samples at two weeks postnatal age.
  
  
  RESULTS
  A delay in enteral feedings after the third postnatal day is associated with a 4.5 (95% CI 1.8-11.5, p=0.002) fold increase in chronic lung disease, 2.9 (1.1-7.8, p=0.03) fold increase in retinopathy of prematurity, and 3.4 (1.2-9.8, p=0.02) fold increase in multiple comorbidities compared to infants fed on or before the third day. Additionally, a delay in the initiation of feedings is associated with increased fecal IL-8 levels and a decreased IL-10:IL-8 ratio.
  
  
  CONCLUSIONS
  A delay in enteral feeding is associated with intestinal inflammation and increased risks of morbidities. To improve neonatal outcomes, early nutritional practices need to be reevaluated.
authors.affiliation: Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, Unites States of America.
authors.forename: Yelizaveta
authors.initials: Y
authors.lastname: Konnikova
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.
authors.forename: Munir M
authors.initials: MM
authors.lastname: Zaman
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.
authors.forename: Meher
authors.initials: M
authors.lastname: Makda
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.
authors.forename: Danila
authors.initials: D
authors.lastname: D'Onofrio
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America; Division of Translational Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Freedman
authors.affiliation: Division of Translational Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America; Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.
authors.forename: Camilia R
authors.initials: CR
authors.lastname: Martin
mesh_terms: D000328:Adult; D004750:Enteral Nutrition / Q000379:methods; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000378:metabolism / Q000502:physiology*; D007235:Infant, Premature, Diseases / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D007249:Inflammation / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D016753:Interleukin-10 / Q000378:metabolism; D016209:Interleukin-8 / Q000378:metabolism; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000473:pathology*; D011181:Postnatal Care / Q000379:methods; D013997:Time Factors
chemical_list: C508609:IL10 protein, human; D016209:Interleukin-8; D016753:Interleukin-10