title: Enteral feeding during indomethacin treatment for patent ductus arteriosus: association with gastrointestinal outcomes.
abstract: Enteral feeds are often discontinued or reduced during indomethacin treatment for patent ductus arteriosus (PDA) in preterm neonates, but the clinical impact of this practice is unknown. The objective of this study was to study the associations between enteral feed volume at the time of indomethacin therapy in preterm neonates with PDA and subsequent gastrointestinal outcomes.
  
  
  
  Retrospective cohort study. Single-center level III Neonatal Intensive Care Unit.
  
  
  
  All consecutive preterm neonates who had received treatment with indomethacin for PDA over a 5-year period were included and categorized based on enteral feed volume exposure during treatment (Group A: nil per oral (NPO, N=229); Group B: ⩽60 ml kg(-1) day(-1) (N=142); Group C:>60 ml kg(-1) day(-1) (N=44)). Baseline characteristics and clinical outcomes were compared between the three groups. The primary outcome was necrotizing enterocolitis (NEC) ⩾stage IIa, while secondary outcomes included other gastrointestinal complications and common prematurity-related morbidities. Group C had a higher gestational age (mean±s.d.; A: 26.3±1.8; B: 26.1±1.8; C: 27.0±2.0 weeks), birth weight (A: 864±239; B: 847±202; C: 932±234 g) and postnatal age at the time of indomethacin treatment (A: 5.3±2.9; B: 7.2±4.9; C: 15.4±6.6 days). All groups had similar rates of the primary outcome NEC (A: 6.1%, B: 7.8% and C: 4.6%, respectively). They also had similar rates of the secondary outcomes with the exception of days to reach enteral feeds of 120 ml kg(-1) day(-1) (A: 22.8±8.5; B: 20.5±8.6; C: 16.8±7.7; P<0.05 for all inter-group comparisons). Secondary analysis including only those neonates who were not already NPO before indomethacin treatment (N=261) and categorized based on preemptive management (made NPO; enteral feed volume reduced; enteral feed volume unchanged/increased) also showed similar results.
  
  
  
  This large retrospective study did not identify any association between enteral feed volumes during indomethacin treatment or preemptive reduction in enteral feeds and subsequent incidence of adverse gastrointestinal outcomes in preterm neonates. Preemptive reduction in enteral feed volume was associated with longer time to reach full enteral feeds.
authors.affiliation: Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Louis
authors.affiliation: Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Torgalkar
authors.affiliation: Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Shah
authors.affiliation: Department of Pediatrics and Health Policy, Management, and Evaluation, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: P S
authors.initials: PS
authors.lastname: Shah
authors.affiliation: Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Jain
mesh_terms: D001724:Birth Weight; D002170:Canada; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000628:therapy*; D004750:Enteral Nutrition; D020345:Enterocolitis, Necrotizing / Q000139:chemically induced / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage* / Q000009:adverse effects; D062071:Infant, Extremely Premature / Q000254:growth & development*; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000254:growth & development*; D007363:Intensive Care Units, Neonatal; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies
chemical_list: D007213:Indomethacin