Lembo Chiara, El-Khuffash Afif, Fusch Christoph, Iacobelli Silvia, Lapillonne Alexandre
Department of Neonatology, APHP, Necker-Enfants Malades Hospital, Paris, France.
Department of Pediatrics (School of Medicine), Royal College of Surgeons in Ireland, Dublin, Ireland.
Pediatr Res. 2023 Aug 10. doi: 10.1038/s41390-023-02754-4.
The persistence of a patent ductus arteriosus (PDA) is a common condition in preterm infants with a prevalence inversely proportional to gestational age. PDA is associated with mild-to-severe gastrointestinal complications such as feeding intolerance, gastrointestinal perforation, and necrotizing enterocolitis, which represent a major challenge for the nutritional management in preterm infants. In this context, the Section on Nutrition, Gastroenterology and Metabolism and the Circulation Section of the European Society for Pediatric Research have joined forces to review the current knowledge on nutritional issues related to PDA in preterm infants. The aim of the narrative review is to discuss the clinical implications for nutritional practice. Because there is little literature on postnatal nutrition and PDA in preterm infants, further research with well-designed studies on this topic is urgently needed. Guidelines should also be developed to clearly define the implementation and course of enteral nutrition and the target nutritional intake before, during, and after pharmacologic or surgical treatment of PDA, when indicated. IMPACT: Persistent ductus arteriosus (PDA) is associated with gastrointestinal complications such as feeding intolerance, gastrointestinal perforation, and necrotizing enterocolitis, which pose a major challenge to the nutritional management of preterm infants. In PDA infants, fluid restriction may lead to inadequate nutrient intake, which may negatively affect postnatal growth and long-term health. The presence of PDA does not appear to significantly affect mesenteric blood flow and splanchnic oxygenation after enteral feedings. Initiation or maintenance of enteral nutrition can be recommended in infants with PDA.
动脉导管未闭（PDA）在早产儿中很常见，其发生率与胎龄成反比。PDA与轻至重度胃肠道并发症相关，如喂养不耐受、胃肠道穿孔和坏死性小肠结肠炎，这对早产儿的营养管理构成了重大挑战。在此背景下，欧洲儿科学会营养、胃肠病学和代谢科与循环科联合起来，对与早产儿PDA相关的营养问题的现有知识进行了综述。叙述性综述的目的是讨论对营养实践的临床意义。由于关于早产儿出生后营养和PDA的文献很少，迫切需要对此主题进行精心设计的进一步研究。还应制定指南，以明确界定在有指征时对PDA进行药物或手术治疗之前、期间和之后肠内营养的实施和过程以及目标营养摄入量。影响：持续性动脉导管未闭（PDA）与喂养不耐受、胃肠道穿孔和坏死性小肠结肠炎等胃肠道并发症相关，这对早产儿的营养管理构成了重大挑战。在患有PDA的婴儿中，液体限制可能导致营养摄入不足，这可能对出生后生长和长期健康产生负面影响。PDA的存在似乎不会显著影响肠内喂养后肠系膜血流和内脏氧合。对于患有PDA的婴儿，可以建议开始或维持肠内营养。
