What is Feeding Intolerance?
Feeding intolerance is a common issue in neonates, especially those who are preterm or have underlying health conditions. It is defined as the inability to digest enteral feedings, leading to symptoms such as gastric residuals, vomiting, abdominal distension, and sometimes, more severe complications like necrotizing enterocolitis (NEC).
Why are Neonates Prone to Feeding Intolerance?
Newborns, particularly preterm infants, have immature gastrointestinal systems. This immaturity affects various aspects such as motility, enzyme production, and mucosal barrier function, making it difficult for them to tolerate feedings. Additionally, conditions like intestinal atresia, gastroschisis, and congenital heart disease can exacerbate feeding difficulties.
Increased gastric residuals
Vomiting or regurgitation
Abdominal distension
Diarrhea or constipation
Lethargy or irritability
How is Feeding Intolerance Diagnosed?
Diagnosis is primarily clinical, based on the observation of symptoms and physical examination. Radiographic studies and abdominal ultrasound can be used to rule out other conditions. Monitoring of gastric residuals and stool patterns can provide additional clues.
Adjusting the feeding regimen (e.g., reducing the volume or rate of feeding)
Switching to a different type of formula or breast milk fortifier
Using medications such as probiotics, prokinetics, or acid suppressants
In severe cases, parenteral nutrition may be necessary
Gradual advancement of feeding volumes
Using human milk or donor milk when possible
Close monitoring of growth and clinical signs
Early identification and management of underlying conditions
What is the Prognosis?
The prognosis for neonates with feeding intolerance varies. Many infants outgrow the condition as their gastrointestinal system matures. However, those with underlying health issues may continue to experience difficulties. Early diagnosis and appropriate management are crucial for improving outcomes.
Symptoms persist despite initial management
The infant shows signs of severe distress or complications
There is suspicion of underlying anatomical or metabolic conditions
