Affiliations: [a] Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Southern Illinois University School of Medicine, IL, USA
| [b] 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
| [c] Department of Pediatrics, Division of Neonatal-Perinatal Medicine, The Children’s Hospital at Montefiore, Albert Einstein College of Medicine, NY, USA
| [d] Department of Epidemiology & Population Health, Division of Biostatistics, Albert Einstein College of Medicine, NY, USA
Address for correspondence: Mohamed Farooq Ahamed, MD, Southern Illinois University School of Medicine, 415 N Ninth Street, P.O. Box 19676, Springfield, IL 62794-9676, USA. Tel.: +1 217 757 6428; Fax: +1 217 757 6844; E-mail: [email protected].
Abstract: OBJECTIVES: 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.