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Randomized Controlled Trial
. 2015 Jul;167(1):47-51.e1.
doi: 10.1016/j.jpeds.2015.04.035. Epub 2015 May 8.

Randomized Clinical Trial of Preoperative Feeding to Evaluate Intestinal Barrier Function in Neonates Requiring Cardiac Surgery

Sinai C Zyblewski  1 , Paul J Nietert  2 , Eric M Graham  3 , Sarah N Taylor  4 , Andrew M Atz  3 , Carol L Wagner  4
Affiliations
Randomized Controlled Trial

Randomized Clinical Trial of Preoperative Feeding to Evaluate Intestinal Barrier Function in Neonates Requiring Cardiac Surgery

Sinai C Zyblewski et al. J Pediatr. 2015 Jul.

Abstract

Objectives: To evaluate intestinal barrier function in neonates undergoing cardiac surgery using lactulose/mannitol (L/M) ratio measurements, and to determine correlations with early breast milk feeding.

Study design: This was a single-center, prospective, randomized pilot study of 27 term-born neonates (≥ 37 weeks gestation) requiring cardiac surgery who were randomized to 1 of 2 preoperative feeding groups: nil per os (NPO) or trophic (10 mL/kg/day) breast milk feeds. At 3 time points (preoperative [preop], postoperative [postop] day 7, and postop day 14), subjects were administered an oral L/M solution, after which urine L/M ratios were measured using gas chromatography, with higher ratios indicative of increased intestinal permeability. Trends over time in the mean urine L/M ratios for each group were estimated using a general linear mixed model.

Results: There were no adverse events related to preoperative trophic feeding. In the NPO group (n = 13), the mean urine L/M ratio was 0.06 at preop, 0.12 at postop day 7, and 0.17 at postop day 14. In the trophic breast milk feeds group (n = 14), the mean urine L/M ratio was 0.09 at preop, 0.19 at postop day 7, and 0.15 at postop day 14. In both groups, L/M ratios were significantly higher at postop day 7 and postop day 14 compared with preop (P < .05).

Conclusion: Neonates have increased intestinal permeability after cardiac surgery extending to at least postop day 14. This pilot study was not powered to detect differences in benefit or adverse events comparing the NPO and trophic breast milk feeds groups. Further studies to identify mechanisms of intestinal injury and therapeutic interventions are warranted.

Trial registration: Registered with ClinicalTrials.gov: NCT01475357.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Box plots of urine lactulose/mannitol ratios by randomization group. The boxes reflect the median (horizontal bars within the boxes) and interquartile ranges. Circles indicate mean values, and squares represent outliers.
Figure 2
Figure 2
CONSORT diagram.
See this image and copyright information in PMC

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