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Nutrition of the preterm infant with persistent ductus arteriosus: existing evidence and practical implications

Pediatric Research (2023)Cite this article

Abstract

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.

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Fig. 1: After birth, the pulmonary vascular resistance drops and the systemic vascular resistance increases, a left-to-right shunt develops with an augmentation of the ductal blood flow.

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Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

References

  1. Lapillonne, A. & Griffin, I. J. Feeding preterm infants today for later metabolic and cardiovascular outcomes. J. Pediatr. 162, S7–S16 (2013).

    Article  PubMed  Google Scholar 

  2. Mitra, S., de Boode, W. P., Weisz, D. E. & Shah, P. S. Interventions for patent ductus arteriosus (PDA) in preterm infants: an overview of Cochrane Systematic Reviews. Cochrane Database Syst. Rev. 4, CD013588 (2023).

    PubMed  Google Scholar 

  3. Verma, R., Shibly, S., Fang, H. & Pollack, S. Do early postnatal body weight changes contribute to neonatal morbidities in the extremely low birth weight infants. J. Neonatal Perinat. Med. 8, 113–118 (2015).

    Article  CAS  Google Scholar 

  4. Hansson, L., Lind, T., Wiklund, U., Öhlund, I. & Rydberg, A. Fluid restriction negatively affects energy intake and growth in very low birthweight infants with haemodynamically significant patent ductus arteriosus. Acta Paediatr. 108, 1985–1992 (2019).

    Article  CAS  PubMed  Google Scholar 

  5. Kim, Y.-J. et al. Extrauterine growth restriction in extremely preterm infants based on the Intergrowth-21st Project Preterm Postnatal Follow-up Study growth charts and the Fenton growth charts. Eur. J. Pediatr. 180, 817–824 (2021).

    Article  PubMed  Google Scholar 

  6. Asbury, M. R. et al. Optimizing the growth of very-low-birth-weight infants requires targeting both nutritional and nonnutritional modifiable factors specific to stage of hospitalization. Am. J. Clin. Nutr. 110, 1384–1394 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  7. Koch, J. et al. Prevalence of spontaneous closure of the ductus arteriosus in neonates at a birth weight of 1000 grams or less. Pediatrics 117, 1113–1121 (2006).

    Article  PubMed  Google Scholar 

  8. Semberova, J. et al. Spontaneous closure of patent ductus arteriosus in infants ≤1500 g. Pediatrics 140, e20164258 (2017).

  9. Deshpande, P., Baczynski, M., McNamara, P. J. & Jain, A. Patent ductus arteriosus: The physiology of transition. Semin. Fetal Neonatal Med. 23, 225–231 (2018).

    Article  PubMed  Google Scholar 

  10. El-Khuffash, A. et al. A patent ductus arteriosus severity score predicts chronic lung disease or death before discharge. J. Pediatr. 167, 1354.e2–1361.e2 (2015).

    Article  Google Scholar 

  11. Kordasz, M. et al. Risk factors for mortality in preterm infants with necrotizing enterocolitis: a retrospective multicenter analysis. Eur. J. Pediatr. 181, 933–939 (2022).

    Article  CAS  PubMed  Google Scholar 

  12. El-Khuffash, A. et al. A pilot randomized controlled trial of early targeted patent ductus arteriosus treatment using a risk based severity score (The PDA RCT). J. Pediatr. 229, 127–133 (2021).

    Article  CAS  PubMed  Google Scholar 

  13. El-Khuffash, A., Higgins, M., Walsh, K. & Molloy, E. J. Quantitative assessment of the degree of ductal steal using celiac artery blood flow to left ventricular output ratio in preterm infants. Neonatology 93, 206–212 (2008).

    Article  PubMed  Google Scholar 

  14. Shimada, S., Kasai, T., Hoshi, A., Murata, A. & Chida, S. Cardiocirculatory effects of patent ductus arteriosus in extremely low-birth-weight infants with respiratory distress syndrome. Pediatr. Int. 45, 255–262 (2003).

    Article  PubMed  Google Scholar 

  15. Hsu, K.-H., Nguyen, J., Dekom, S., Ramanathan, R. & Noori, S. Effects of patent ductus arteriosus on organ blood flow in infants born very preterm: a prospective study with serial echocardiography. J. Pediatr. 216, 95.e2–100.e2 (2020).

    Article  Google Scholar 

  16. Cavalcanti, L. S. et al. Serial Doppler velocimetry of mesenteric and portal flow in very-low-birth-weight preterm neonates with and without patent ductus arteriosus. Pediatr. Radiol. 50, 1107–1114 (2020).

    Article  PubMed  Google Scholar 

  17. van Laere, D. et al. Application of NPE in the assessment of a patent ductus arteriosus. Pediatr. Res. 84, 46–56 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  18. El Atawi, K., Unde, N. & Elhalik, M. Patent ductus arteriosus (PDA) staging and splanchnic circulation in high risk preterm infants. J. Pediatr. Neonatal Care 9, 100–104 (2019).

    Article  Google Scholar 

  19. Bruns, N. et al. How to administer near-infrared spectroscopy in critically ill neonates, infants, and children. J. Vis. Exp. https://doi.org/10.3791/61533 (2020).

  20. Ledo, A., Aguar, M., Núñez-Ramiro, A., Saénz, P. & Vento, M. Abdominal near-infrared spectroscopy detects low mesenteric perfusion early in preterm infants with hemodynamic significant ductus arteriosus. Neonatology 112, 238–245 (2017).

    Article  CAS  PubMed  Google Scholar 

  21. Huang, X.-B., Zhong, X., Liu, T., Cheng, G.-Q. & Qiu, H.-X. Value of near-infrared spectroscopy in monitoring intestinal tissue oxygen saturation in preterm infants with hemodynamically significant patent ductus arteriosus: a prospective research. Zhongguo Dang Dai Er Ke Za Zhi 23, 821–827 (2021).

    PubMed  Google Scholar 

  22. Louis, D., Mukhopadhyay, K., Sodhi, K. S., Jain, V. & Kumar, P. Superior mesenteric artery Doppler is poor at predicting feed intolerance and NEC in preterm small for gestational age neonates. J. Matern. Neonatal Med. 26, 1855–1859 (2013).

    Article  Google Scholar 

  23. Urboniene, A., Palepsaitis, A., Uktveris, R. & Barauskas, V. Doppler flowmetry of the superior mesenteric artery and portal vein: impact for the early prediction of necrotizing enterocolitis in neonates. Pediatr. Surg. Int. 31, 1061–1066 (2015).

    Article  PubMed  Google Scholar 

  24. McCurnin, D. & Clyman, R. I. Effects of a patent ductus arteriosus on postprandial mesenteric perfusion in premature baboons. Pediatrics 122, e1262–e1267 (2008).

    Article  PubMed  Google Scholar 

  25. Havranek, T., Rahimi, M., Hall, H. & Armbrecht, E. Feeding preterm neonates with patent ductus arteriosus (PDA): intestinal blood flow characteristics and clinical outcomes. J. Matern. Neonatal Med. 28, 526–530 (2015).

    Article  Google Scholar 

  26. Guang, Y. et al. Early Doppler ultrasound in the superior mesenteric artery and the prediction of necrotizing enterocolitis in preterm neonates. J. Ultrasound Med. 38, 3283–3289 (2019).

    Article  PubMed  Google Scholar 

  27. Falciglia, G. H. et al. Association between the 7-day moving average for nutrition and growth in very low birth weight infants. JPEN J. Parenter. Enter. Nutr. 42, 805–812 (2018).

    Google Scholar 

  28. Marks, K.-A., Reichman, B., Lusky, A. & Zmora, E. Fetal growth and postnatal growth failure in very-low-birthweight infants. Acta Paediatr. 95, 236–242 (2006).

    Article  PubMed  Google Scholar 

  29. Ofek Shlomai, N., Reichman, B., Zaslavsky-Paltiel, I., Lerner-Geva, L. & Eventov-Friedman, S. Neonatal morbidities and postnatal growth failure in very low birth weight, very preterm infants. Acta Paediatr. 111, 1536–1545 (2022).

    Article  PubMed  Google Scholar 

  30. Wang, L. et al. Risk factors of extrauterine growth restriction in very preterm infants with bronchopulmonary dysplasia: a multi-center study in China. BMC Pediatr. 22, 363 (2022).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Babla, K., Dassios, T., Pushparajah, K., Hickey, A. & Greenough, A. Premature infants with patent ductus arteriosus: postnatal growth according to type of management. Pediatr. Neonatol. 62, 36–40 (2021).

    Article  PubMed  Google Scholar 

  32. Westin, V., Stoltz Sjöström, E., Ahlsson, F., Domellöf, M. & Norman, M. Perioperative nutrition in extremely preterm infants undergoing surgical treatment for patent ductus arteriosus is suboptimal. Acta Paediatr. 103, 282–288 (2014).

    Article  CAS  PubMed  Google Scholar 

  33. Moltu, S. J. et al. Nutritional management of the critically ill neonate: a position paper of the ESPGHAN Committee on nutrition. J. Pediatr. Gastroenterol. Nutr. 73, 274–289 (2021).

    PubMed  Google Scholar 

  34. Diez, S. et al. Prediction of high Bell stages of necrotizing enterocolitis using a mathematic formula for risk determination. Children 9, 604 (2022).

  35. Song, S., Zhang, J., Zhao, Y. & Dai, L. Development and validation of a nomogram for predicting the risk of Bell’s stage II/III necrotizing enterocolitis in neonates compared to Bell’s stage I. Front. Pediatr. 10, 863719 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  36. Diez, S. et al. Clinical characteristics of necrotizing enterocolitis in preterm patients with and without persistent ductus arteriosus and in patients with congenital heart disease. Front. Pediatr. 8, 257 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  37. Wei, Y.-J. et al. The association of patent ductus arteriosus with inflammation: a narrative review of the role of inflammatory biomarkers and treatment strategy in premature infants. Int. J. Mol. Sci. 23, 13877 (2022).

  38. Ohlsson, A. & Shah, P. S. Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low birth weight infants. Cochrane Database Syst. Rev. 1, CD010061 (2020).

    PubMed  Google Scholar 

  39. Ohlsson, A., Walia, R. & Shah, S. S. Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight (or both) infants. Cochrane Database Syst. Rev. 2, CD003481 (2020).

    PubMed  Google Scholar 

  40. Coombs, R. C., Morgan, M. E., Durbin, G. M., Booth, I. W. & McNeish, A. S. Gut blood flow velocities in the newborn: effects of patent ductus arteriosus and parenteral indomethacin. Arch. Dis. Child. 65, 1067–1071 (1990).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Fujii, A. M., Brown, E., Mirochnick, M., O’Brien, S. & Kaufman, G. Neonatal necrotizing enterocolitis with intestinal perforation in extremely premature infants receiving early indomethacin treatment for patent ductus arteriosus. J. Perinatol. 22, 535–540 (2002).

    Article  PubMed  Google Scholar 

  42. Hamrick, S. E. G. et al. Patent ductus arteriosus of the preterm infant. Pediatrics 146, e20201209 (2020).

  43. Shaffer, M. L. et al. Effect of prophylaxis for early adrenal insufficiency using low-dose hydrocortisone in very preterm infants: an individual patient data meta-analysis. J. Pediatr. 207, e5 (2019).

    Article  Google Scholar 

  44. Mayer, A., Francescato, G., Pesenti, N., Schena, F. & Mosca, F. Patent ductus arteriosus and spontaneous intestinal perforation in a cohort of preterm infants. J. Perinatol. 42, 1649–1653 (2022).

  45. Bell, E. F., Acarregui, M. J. & and Cochrane Neonatal Group. Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants. Cochrane Database Syst. Rev. 2014, CD000503 (2008).

  46. Francescato, G. et al. Fluid restriction in management of patent ductus arteriosus in Italy: a nationwide survey. Eur. J. Pediatr. 182, 393–401 (2023).

    Article  PubMed  Google Scholar 

  47. Stephens, B. E. et al. Fluid regimens in the first week of life may increase risk of patent ductus arteriosus in extremely low birth weight infants. J. Perinatol. 28, 123–128 (2008).

    Article  CAS  PubMed  Google Scholar 

  48. De Buyst, J., Rakza, T., Pennaforte, T., Johansson, A.-B. & Storme, L. Hemodynamic effects of fluid restriction in preterm infants with significant patent ductus arteriosus. J. Pediatr. 161, 404–408 (2012).

    Article  PubMed  Google Scholar 

  49. Jain, A. & Shah, P. S. Diagnosis, evaluation, and management of patent ductus arteriosus in preterm neonates. JAMA Pediatr. 169, 863–872 (2015).

    Article  PubMed  Google Scholar 

  50. Petrova, A., Bhatt, M. & Mehta, R. Regional tissue oxygenation in preterm born infants in association with echocardiographically significant patent ductus arteriosus. J. Perinatol. 31, 460–464 (2011).

    Article  CAS  PubMed  Google Scholar 

  51. Christmann, V., Liem, K. D., Semmekrot, B. A. & van de Bor, M. Changes in cerebral, renal and mesenteric blood flow velocity during continuous and bolus infusion of indomethacin. Acta Paediatr. 91, 440–446 (2002).

    Article  CAS  PubMed  Google Scholar 

  52. Yanowitz, T. D. et al. Superior mesenteric artery blood flow velocities following medical treatment of a patent ductus arteriosus. J. Pediatr. 164, 661–663 (2014).

    Article  PubMed  Google Scholar 

  53. Wadhawan, R. et al. Spontaneous intestinal perforation in extremely low birth weight infants: association with indometacin therapy and effects on neurodevelopmental outcomes at 18-22 months corrected age. Arch. Dis. Child. Fetal Neonatal Ed. 98, F127–F132 (2013).

    Article  PubMed  Google Scholar 

  54. Vane, J. R. & Botting, R. M. Mechanism of action of anti-inflammatory drugs. Adv. Exp. Med. Biol. 433, 131–138 (1997).

    Article  CAS  PubMed  Google Scholar 

  55. Bhatt, M., Petrova, A. & Mehta, R. Does treatment of patent ductus arteriosus with cyclooxygenase inhibitors affect neonatal regional tissue oxygenation? Pediatr. Cardiol. 33, 1307–1314 (2012).

    Article  PubMed  Google Scholar 

  56. Guzoglu, N. et al. Renal and mesenteric tissue oxygenation in preterm infants treated with oral ibuprofen. J. Matern. Neonatal Med. 27, 197–203 (2014).

    Article  CAS  Google Scholar 

  57. Pereira-da-Silva, L., Pita, A., Virella, D. & Serelha, M. Oral ibuprofen for patent ductus arteriosus closure in preterm infants: does high osmolality matter? Am. J. Perinatol. 25, 319–320 (2008).

    Article  PubMed  Google Scholar 

  58. Tatli, M. M. et al. Spontaneous intestinal perforation after oral ibuprofen treatment of patent ductus arteriosus in two very-low-birthweight infants. Acta Paediatr. 93, 999–1001 (2004).

    Article  CAS  PubMed  Google Scholar 

  59. Oncel, M. Y. & Erdeve, O. Oral medications regarding their safety and efficacy in the management of patent ductus arteriosus. World J. Clin. Pediatr. 5, 75–81 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  60. Surak, A. & Hyderi, A. What are the minimal feeds required for starting enteral ibuprofen in preterm infants with PDA? Pediatr. Rep. 14, 333–337 (2022).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Graham, G. G., Davies, M. J., Day, R. O., Mohamudally, A. & Scott, K. F. The modern pharmacology of paracetamol: therapeutic actions, mechanism of action, metabolism, toxicity and recent pharmacological findings. Inflammopharmacology 21, 201–232 (2013).

    Article  CAS  PubMed  Google Scholar 

  62. Zi-Yun, X., Ruo-Lin, Z., Yue-Wei, X. & Tao, B. Efficacy and safety of oral acetaminophen for premature infants with patent ductus arteriosus: a meta-analysis. Front. Pharmacol. 12, 696417 (2021).

    Article  PubMed  Google Scholar 

  63. Huang, X., Wang, F. & Wang, K. Paracetamol versus ibuprofen for the treatment of patent ductus arteriosus in preterm neonates: a meta-analysis of randomized controlled trials. J. Matern. Neonatal Med. 31, 2216–2222 (2018).

    Article  CAS  Google Scholar 

  64. Terrin, G. et al. Paracetamol for the treatment of patent ductus arteriosus in preterm neonates: a systematic review and meta-analysis. Arch. Dis. Child. Fetal Neonatal Ed. 101, F127–F136 (2016).

    Article  PubMed  Google Scholar 

  65. Sivanandan, S. & Agarwal, R. Pharmacological closure of patent ductus arteriosus: selecting the agent and route of administration. Paediatr. Drugs 18, 123–138 (2016).

    Article  PubMed  Google Scholar 

  66. Allegaert, K. et al. Intra- and interindividual variability of glucuronidation of paracetamol during repeated administration of propacetamol in neonates. Acta Paediatr. 94, 1273–1279 (2005).

    Article  PubMed  Google Scholar 

  67. Ferguson, J. M. Pharmacotherapy for patent ductus arteriosus closure. Congenit. Heart Dis. 14, 52–56 (2019).

    PubMed  Google Scholar 

  68. Corvaglia, L. et al. Predictors of full enteral feeding achievement in very low birth weight infants. PLoS ONE 9, e92235 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  69. Mosalli, R. & Alfaleh, K. Prophylactic surgical ligation of patent ductus arteriosus for prevention of mortality and morbidity in extremely low birth weight infants. Cochrane Database Syst. Rev. 2008, CD006181 (2008).

    PubMed  PubMed Central  Google Scholar 

  70. Lee, J. H. et al. Surgical ligation on significant patent ductus arteriosus in very low birth weight infants: comparison between early and late ligations. Korean J. Thorac. Cardiovasc. Surg. 47, 444–450 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  71. Ibrahim, M. H. et al. Outcomes of early ligation of patent ductus arteriosus in preterms, multicenter experience. Medicine 94, e915 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  72. Matheson, P. J., Wilson, M. A. & Garrison, R. N. Regulation of intestinal blood flow. J. Surg. Res. 93, 182–196 (2000).

    Article  CAS  PubMed  Google Scholar 

  73. Gladman, G., Sims, D. G. & Chiswick, M. L. Gastrointestinal blood flow velocity after the first feed. Arch. Dis. Child. 66, 17–20 (1991).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Martinussen, M., Brubakk, A. M., Vik, T. & Yao, A. C. Mesenteric blood flow velocity and its relation to transitional circulatory adaptation in appropriate for gestational age preterm infants. Pediatr. Res. 39, 275–280 (1996).

    Article  CAS  PubMed  Google Scholar 

  75. Corvaglia, L. et al. Bolus vs. continuous feeding: effects on splanchnic and cerebral tissue oxygenation in healthy preterm infants. Pediatr. Res. 76, 81–85 (2014).

    Article  PubMed  Google Scholar 

  76. Dave, V. et al. Splanchnic tissue oxygenation, but not brain tissue oxygenation, increases after feeds in stable preterm neonates tolerating full bolus orogastric feeding. J. Perinatol. 29, 213–218 (2009).

    Article  CAS  PubMed  Google Scholar 

  77. Surmeli Onay, O. et al. The effect of drip versus intermittent feeding on splanchnic oxygenation in preterm infants with intrauterine growth restriction: a prospective randomized trial. Eur. J. Pediatr. 182, 1317–1328 (2023).

    Article  CAS  PubMed  Google Scholar 

  78. Pezzati, M. et al. Prediction of early tolerance to enteral feeding by measurement of superior mesenteric artery blood flow velocity: appropriate- versus small-for-gestational-age preterm infants. Acta Paediatr. 93, 797–802 (2004).

    Article  CAS  PubMed  Google Scholar 

  79. Fang, S., Kempley, S. T. & Gamsu, H. R. Prediction of early tolerance to enteral feeding in preterm infants by measurement of superior mesenteric artery blood flow velocity. Arch. Dis. Child. Fetal Neonatal Ed. 85, F42–F45 (2001).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  80. Yanowitz, T. D. et al. Effects of prophylactic low-dose indomethacin on hemodynamics in very low birth weight infants. J. Pediatr. 132, 28–34 (1998).

    Article  CAS  PubMed  Google Scholar 

  81. Lemyre, B., Liu, L., Moore, G. P., Lawrence, S. L. & Barrowman, N. J. Do intra-operative fluids influence the need for post-operative cardiotropic support after a PDA ligation? Zhongguo Dang Dai Er Ke Za Zhi 13, 1–7 (2011).

    PubMed  Google Scholar 

  82. Giesinger, R. E., Bischoff, A. R. & McNamara, P. J. Anticipatory perioperative management for patent ductus arteriosus surgery: understanding postligation cardiac syndrome. Congenit. Heart Dis. 14, 311–316 (2019).

    Article  PubMed  Google Scholar 

  83. Embleton, N. D. et al. Enteral nutrition in preterm infants (2022): a Position Paper from the ESPGHAN Committee on nutrition and invited experts. J. Pediatr. Gastroenterol. Nutr. 76, 248–268 (2023).

    PubMed  Google Scholar 

  84. Bellander, M., Ley, D., Polberger, S. & Hellström-Westas, L. Tolerance to early human milk feeding is not compromised by indomethacin in preterm infants with persistent ductus arteriosus. Acta Paediatr. 92, 1074–1078 (2003).

    Article  CAS  PubMed  Google Scholar 

  85. Clyman, R. et al. Enteral feeding during indomethacin and ibuprofen treatment of a patent ductus arteriosus. J. Pediatr. 163, 406–411 (2013).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  86. Kaur, S. et al. The dilemma of feeding during the treatment of patent ductus arteriosus with oral ibuprofen in preterm infants ≤30 weeks of gestation-a randomized controlled trial. J. Perinatol. 43, 203–208 (2023).

    Article  CAS  PubMed  Google Scholar 

  87. Martini, S. et al. To feed or not to feed: a critical overview of enteral feeding management and gastrointestinal complications in preterm neonates with a patent ductus arteriosus. Nutrients 12, 83 (2019).

  88. Patole, S. K., Kumaran, V., Travadi, J. N., Brooks, J. M. & Doherty, D. A. Does patent ductus arteriosus affect feed tolerance in preterm neonates? Arch. Dis. Child. Fetal Neonatal Ed. 92, F53–F55 (2007).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  89. Xu, J. H. et al. A national survey of the enteral feeding practices in Canadian neonatal intensive care units. Paediatr. Child Health 25, 529–533 (2020).

    Article  PubMed  Google Scholar 

  90. Hu, X. et al. Survey on human milk feeding and enteral feeding practices for very-low-birth-weight infants in NICUs in China Neonatal Network. BMC Pediatr. 23, 75 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

Funding

This project has been funded by the non-profit organization ARFEN. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Neonatology, APHP, Necker-Enfants Malades Hospital, Paris, France

    Chiara Lembo & Alexandre Lapillonne

  2. Department of Pediatrics (School of Medicine), Royal College of Surgeons in Ireland, Dublin, Ireland

    Afif El-Khuffash

  3. Neonatology, Department of Pediatrics, General Hospital, Paracelsus Medical School, Nuernberg, Germany

    Christoph Fusch

  4. McMaster Children’s Hospital, Hamilton Health Sciences, Hamilton, ON, Canada

    Christoph Fusch

  5. Réanimation Néonatale et Pédiatrique, CHU La Réunion, Saint-Pierre, France

    Silvia Iacobelli

  6. EHU 7328 PACT, Paris Cite University, Paris, France

    Alexandre Lapillonne

  7. Department of Neonatology, Instituto de Investigación Sanitaria, La Paz University Hospital-IdiPAZ (Universidad Autonoma), Madrid, Spain

    Miguel Sáenz de Pipaón

  8. Division of Paediatric and Adolescent Medicine, Department of Neonatal Intensive Care, Ullevål, Oslo University Hospital, Oslo, Norway

    Sissel J. Moltu

  9. Hans Christian Andersen Children’s Hospital, Department of Neonatology, Odense University Hospital, 5000, Odense, Denmark

    Gitte Zachariassen

  10. Department of Clinical Research, University of Southern, 5000, Odense, Denmark

    Gitte Zachariassen

  11. Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK

    Mark J. Johnson

  12. NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK

    Mark J. Johnson

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on behalf of ESPR Nutrition council members

  • Miguel Sáenz de Pipaón
  • , Alexandre Lapillonne
  • , Sissel J. Moltu
  • , Gitte Zachariassen
  • , Mark J. Johnson
  • , Christoph Fusch
  •  & Silvia Iacobelli

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C.L., A.E.-K., S.I., and A.L. drafted the manuscript. C.F. provided important scientific contribution. All authors and all the members of the ESPR Nutrition council members reviewed or approved the final manuscript. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

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Lembo, C., El-Khuffash, A., Fusch, C. et al. Nutrition of the preterm infant with persistent ductus arteriosus: existing evidence and practical implications. Pediatr Res (2023). https://doi.org/10.1038/s41390-023-02754-4

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