Application of Additional Research Methods in Case of Food Tolerance Disorders in Preterm Infants
Year: 2025
Type: article
Study design: Case Report
Abstract: Food intolerance and necrotizing enterocolitis (NEC) remain leading causes of morbidity and mortality among preterm infants. The absence of universal diagnostic criteria for food intolerance, along with the variability of clinical symptoms, complicates early diagnosis and the determination of optimal enteral feeding strategies. Traditional diagnostic methods, particularly X-rays, have limited prognostic value and often detect the disease at advanced stages. In this context, the use of non-invasive methods for assessing intestinal motility and perfusion, such as Doppler ultrasound of the superior mesenteric artery (SMA), near-infrared spectroscopy (NIRS), and electronic auscultation of bowel sounds, becomes highly relevant. The aim of our study was to evaluate the diagnostic significance of the combined use of additional instrumental examination methods in cases of feeding intolerance (FI) in extremely preterm infants, particularly their ability to predict the development of NEC and determine subsequent enteral feeding strategies. Methods. The study was conducted in the neonatal intensive care unit. Clinical cases are presented involving the management of preterm twins with a gestational age (GA) of 28 weeks who experienced difficulties in advancing enteral feeding. As additional diagnostic tools, Doppler ultrasound of the SMA was used to assess vascular perfusion, NIRS to determine the level of splanchnic oxygenation, and electronic auscultation of bowel sounds for objective analysis of peristaltic activity. The obtained data were compared with clinical parameters, patient status dynamics, and laboratory markers of inflammation. Results. An increase in the resistive index (RI) of the superior mesenteric artery (SMA) after a period of conditional stabilization in the infant, combined with a decrease in bowel sounds, preceded the development of NEC. High resistance in the SMA indicates vasoconstriction of the intestinal vessels, which may be a compensatory mechanism in response to hypoxia or systemic hemodynamic instability. A decrease in the number of bowel sounds further confirms ischemic intestinal injury. An increase in SMA RI against a background of enhanced bowel sounds during stable enteral feeding may indicate functional activation of the intestine with preserved motor activity but reduced perfusion. A high SMA RI combined with active bowel sounds may be a marker of compensatory hyperperistalsis in the early stages of ischemia. A decrease in SMA RI corresponded to the complication of NEC—perforation. Loss of vascular tone is a sign of critical damage to the intestinal wall. Average levels of NIRS indicators corresponded to the phase of sustained enteral feeding (EF) expansion. This suggests that perfusion of the intestine in the initial stages was sufficient to maintain functional activity. A significant increase in absolute NIRS values correlated with the manifestation of NEC, indicating an initial inflammatory phase where local vasodilation may be a compensatory mechanism. A marked decrease in NIRS corresponded to disease progression, worsening clinical parameters, and absolute inability to tolerate enteral feeding. Conclusions. The application of a comprehensive approach using Doppler ultrasound of the SMA, NIRS, and electronic auscultation of bowel sounds allows not only the diagnosis of NEC at early stages but also the prediction of the risk of complications. The combined use of these methods makes it possible to personalize the approach to enteral feeding for newborns at high risk of complications.
Authors: A. Khorosh, O. Kapustina
Institution: Dnipro State Medical University
Language: English
Topic: Infant Nutrition and Health
Subfield: Nutrition and Dietetics
Field: Nursing
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4412477594