title: Early feeding tolerance in small for gestational age infants with normal versus abnormal antenatal Doppler characteristics.
abstract: OBJECTIVE
  To determine differences in feeding tolerance amongst preterm small for gestational age (SGA) infants with normal versus abnormal umbilical artery Doppler flow defined as absent or reversed end diastolic flow (AREDF).
  
  
  METHODS
  This was a retrospective cohort study of infants <35 weeks gestational age (GA) and birth weight (BW) <10th percentile. Day of initiation of feeds, days to full feeds and CRIB II scores were the primary outcomes. Clinical characteristics were compared between the groups of SGA infants with normal and AREDF. Multivariable regression models were fit to the data to adjust for potential confounders of the association of AREDF and feeding intolerance.
  
  
  RESULTS
  120 infants with normal and 64 infants with AREDF were included. The infants with AREDF were smaller (971 g vs. 1183 g, p = 0.0002), less mature (29.9 wks vs. 31.2 wks, p = 0.0009), had higher CRIB II score (7.2 vs. 5.2, p = 0.0033), started feeding later (4.1 days vs. 3.3 days, p = 0.020) and advanced slower to full feeds (17.7 days vs. 13.7 days, p = 0.0017). Necrotizing enterocolitis was similar between the groups (p = 0.18). After adjusting for confounders, Doppler flow was no longer a significant predictor of the initiation (p = 0.37) and advancement of feeds (p = 0.44).
  
  
  CONCLUSIONS
  Infants with AREDF are sicker at birth and have more feeding difficulties; after adjusting for BW and GA, Doppler flow was no longer a significant predictor of feeding intolerance.
authors.affiliation: Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Southern Illinois University School of Medicine, IL, USA.
authors.forename: M F
authors.initials: MF
authors.lastname: Ahamed
authors.affiliation: Department of Obstetrics and Gynecology and Women's Health, Division of Fetal Medicine and OBGYN Ultrasound, Montefiore Medical Center, Albert Einstein College of Medicine, NY, USA.
authors.forename: Pe'er
authors.initials: P
authors.lastname: Dar
authors.affiliation: Department of Pediatrics, Division of Neonatal-Perinatal Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, NY, USA.
authors.forename: M
authors.initials: M
authors.lastname: Vega
authors.affiliation: Department of Epidemiology & Population Health, Division of Biostatistics, Albert Einstein College of Medicine, NY, USA.
authors.forename: Mimi
authors.initials: M
authors.lastname: Kim
authors.affiliation: Department of Epidemiology & Population Health, Division of Biostatistics, Albert Einstein College of Medicine, NY, USA.
authors.forename: Q
authors.initials: Q
authors.lastname: Gao
authors.affiliation: Department of Pediatrics, Division of Neonatal-Perinatal Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, NY, USA.
authors.forename: T
authors.initials: T
authors.lastname: Havranek
mesh_terms: D020345:Enterocolitis, Necrotizing / Q000453:epidemiology; D005247:Feeding Behavior; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D017078:Laser-Doppler Flowmetry; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D013997:Time Factors; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: IUGR; feeding tolerance; growth restriction