Author ORCID Identifier
Doctor of Philosophy
Dr. Lisa F. Brown, PhD, RN
Dr. Nancy Jallo
Dr. Karen Henricks-Munoz
Dr. Leroy Thacker
SPLANCHNIC OXYGENATION AND FEEDING INTOLERANCE IN THE VERY LOW BIRTHWEIGHT INFANT
By Melissa C. Dollings, Ph.D.
A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University
Virginia Commonwealth University, 2022
Major Director: Lisa F. Brown, Ph.D., RN, School of Nursing
Background. Feeding intolerance is common in preterm infants but can be an ominous precursor of necrotizing enterocolitis, a life-threatening gastrointestinal disease. The definition and management of feeding intolerance vary widely. This research examined the relationship
between feeding intolerance, intrauterine factors, extrauterine factors, and intestinal immaturity and circulatory immaturity in the premature, very low birthweight infant. It also explored the use of splanchnic oxygenation (a marker of intestinal perfusion) as an objective measure of feeding intolerance.
Methods. Near infrared spectroscopy (NIRS) monitoring (sensors that measure oxygenation of the tissues) was placed on 20 premature very low birthweight infants during the first few days of life and again if they developed feeding intolerance (n=6). Fractional tissue oxygen extraction (FTOE) was used as a marker for splanchnic oxygenation rather than splanchnic oxygenation (rSO2) alone as it measures the ability of the tissue to extract oxygen. Variables related to intestinal immaturity, circulatory immaturity, intrauterine factors and extrauterine factors were also collected.
Results. There was a significant difference between FTOE at baseline and FTOE during feeding intolerance. However, the FTOE during feeding intolerance was lower. The significant extrauterine and circulatory immaturity factors were the 10-minute Apgar and the presence of hypotension, respectively.
Conclusions. There was a significant difference in FTOE and feeding intolerance, albeit, in an unexpected direction. This may have been related to gut maturation between baseline and feeding intolerance measurements spanning from 2-4 weeks after birth. Further research with more frequent splanchnic oxygenation measurements may explain this finding.
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