Abstract

Objectives: Feeding intolerance (FI) in preterm infants is common but the etiology remains unclear. This study examined FI as a stress-related disease involving brain-gut interactions and tested the model of allostatic load and complications of prematurity. Specific aims were to describe demographic/medical variables and biomarker levels at each time and over time for the sample; describe/compare variables and biomarker levels at each time for infants with/without FI; and compare biomarker interquartile/interpercentile distributions between infants with/without FI. Methods: Preterm infants <32 weeks' gestation were recruited. The primary outcome was FI by day 7 defined as a feeding withheld, discontinued, or decreased because the infant was not tolerating enteral feedings. Allostatic load was operationalized using cortisol and 8-hydroxydeoxyguanosine (8-OHdG) from cord blood and from saliva and urine on days 1, 7, and 14. Descriptive statistics and comparative analyses were performed. Results: Seven of 31 infants enrolled met criteria for FI. Infants with FI had lower median urinary cortisol on day 1 (P=0.007) and trended to have lower cortisol in the cord blood (P=0.056). Interquartile distributions were significantly different between infants with/without FI for urinary cortisol on day 1 (P=0.034) and trended for differences in 8-OHdG on day 14 (P=0.087). Interpercentile distributions were significantly different in salivary cortisol on day 14 (P=0.034) and trended for differences in 8-OHdG on day 1 (P=0.079). Conclusions: Results support further testing of the model in a larger sample; investigation of the cellular mechanisms associated with the stress and the free radical/antioxidant systems; and inclusion of prenatal factors.

Original languageEnglish (US)
Pages (from-to)356-362
Number of pages7
JournalJournal of pediatric gastroenterology and nutrition
Volume57
Issue number3
DOIs
StatePublished - Sep 1 2013

Fingerprint

Premature Infants
Biomarkers
Hydrocortisone
Allostasis
Fetal Blood
Brain Diseases
Enteral Nutrition
Saliva
Free Radicals
Antioxidants
Demography
Urine
Pregnancy

Keywords

  • allostatic load
  • complications of prematurity
  • feeding intolerance
  • preterm infant
  • stress

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Gastroenterology

Cite this

@article{13fc9bb434fe4ada8467870910ed9f26,
title = "Relations between feeding intolerance and stress biomarkers in preterm infants",
abstract = "Objectives: Feeding intolerance (FI) in preterm infants is common but the etiology remains unclear. This study examined FI as a stress-related disease involving brain-gut interactions and tested the model of allostatic load and complications of prematurity. Specific aims were to describe demographic/medical variables and biomarker levels at each time and over time for the sample; describe/compare variables and biomarker levels at each time for infants with/without FI; and compare biomarker interquartile/interpercentile distributions between infants with/without FI. Methods: Preterm infants <32 weeks' gestation were recruited. The primary outcome was FI by day 7 defined as a feeding withheld, discontinued, or decreased because the infant was not tolerating enteral feedings. Allostatic load was operationalized using cortisol and 8-hydroxydeoxyguanosine (8-OHdG) from cord blood and from saliva and urine on days 1, 7, and 14. Descriptive statistics and comparative analyses were performed. Results: Seven of 31 infants enrolled met criteria for FI. Infants with FI had lower median urinary cortisol on day 1 (P=0.007) and trended to have lower cortisol in the cord blood (P=0.056). Interquartile distributions were significantly different between infants with/without FI for urinary cortisol on day 1 (P=0.034) and trended for differences in 8-OHdG on day 14 (P=0.087). Interpercentile distributions were significantly different in salivary cortisol on day 14 (P=0.034) and trended for differences in 8-OHdG on day 1 (P=0.079). Conclusions: Results support further testing of the model in a larger sample; investigation of the cellular mechanisms associated with the stress and the free radical/antioxidant systems; and inclusion of prenatal factors.",
keywords = "allostatic load, complications of prematurity, feeding intolerance, preterm infant, stress",
author = "Moore, {Tiffany A.} and Wilson, {Margaret E.} and Schmid, {Kendra K.} and Ann Anderson-Berry and French, {Jeffrey A.} and Berger, {Ann M.}",
year = "2013",
month = "9",
day = "1",
doi = "10.1097/MPG.0b013e3182953093",
language = "English (US)",
volume = "57",
pages = "356--362",
journal = "Journal of Pediatric Gastroenterology and Nutrition",
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number = "3",

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TY - JOUR

T1 - Relations between feeding intolerance and stress biomarkers in preterm infants

AU - Moore, Tiffany A.

AU - Wilson, Margaret E.

AU - Schmid, Kendra K.

AU - Anderson-Berry, Ann

AU - French, Jeffrey A.

AU - Berger, Ann M.

PY - 2013/9/1

Y1 - 2013/9/1

N2 - Objectives: Feeding intolerance (FI) in preterm infants is common but the etiology remains unclear. This study examined FI as a stress-related disease involving brain-gut interactions and tested the model of allostatic load and complications of prematurity. Specific aims were to describe demographic/medical variables and biomarker levels at each time and over time for the sample; describe/compare variables and biomarker levels at each time for infants with/without FI; and compare biomarker interquartile/interpercentile distributions between infants with/without FI. Methods: Preterm infants <32 weeks' gestation were recruited. The primary outcome was FI by day 7 defined as a feeding withheld, discontinued, or decreased because the infant was not tolerating enteral feedings. Allostatic load was operationalized using cortisol and 8-hydroxydeoxyguanosine (8-OHdG) from cord blood and from saliva and urine on days 1, 7, and 14. Descriptive statistics and comparative analyses were performed. Results: Seven of 31 infants enrolled met criteria for FI. Infants with FI had lower median urinary cortisol on day 1 (P=0.007) and trended to have lower cortisol in the cord blood (P=0.056). Interquartile distributions were significantly different between infants with/without FI for urinary cortisol on day 1 (P=0.034) and trended for differences in 8-OHdG on day 14 (P=0.087). Interpercentile distributions were significantly different in salivary cortisol on day 14 (P=0.034) and trended for differences in 8-OHdG on day 1 (P=0.079). Conclusions: Results support further testing of the model in a larger sample; investigation of the cellular mechanisms associated with the stress and the free radical/antioxidant systems; and inclusion of prenatal factors.

AB - Objectives: Feeding intolerance (FI) in preterm infants is common but the etiology remains unclear. This study examined FI as a stress-related disease involving brain-gut interactions and tested the model of allostatic load and complications of prematurity. Specific aims were to describe demographic/medical variables and biomarker levels at each time and over time for the sample; describe/compare variables and biomarker levels at each time for infants with/without FI; and compare biomarker interquartile/interpercentile distributions between infants with/without FI. Methods: Preterm infants <32 weeks' gestation were recruited. The primary outcome was FI by day 7 defined as a feeding withheld, discontinued, or decreased because the infant was not tolerating enteral feedings. Allostatic load was operationalized using cortisol and 8-hydroxydeoxyguanosine (8-OHdG) from cord blood and from saliva and urine on days 1, 7, and 14. Descriptive statistics and comparative analyses were performed. Results: Seven of 31 infants enrolled met criteria for FI. Infants with FI had lower median urinary cortisol on day 1 (P=0.007) and trended to have lower cortisol in the cord blood (P=0.056). Interquartile distributions were significantly different between infants with/without FI for urinary cortisol on day 1 (P=0.034) and trended for differences in 8-OHdG on day 14 (P=0.087). Interpercentile distributions were significantly different in salivary cortisol on day 14 (P=0.034) and trended for differences in 8-OHdG on day 1 (P=0.079). Conclusions: Results support further testing of the model in a larger sample; investigation of the cellular mechanisms associated with the stress and the free radical/antioxidant systems; and inclusion of prenatal factors.

KW - allostatic load

KW - complications of prematurity

KW - feeding intolerance

KW - preterm infant

KW - stress

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U2 - 10.1097/MPG.0b013e3182953093

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JO - Journal of Pediatric Gastroenterology and Nutrition

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