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Biomedical subjects

C L Berseth

Publications and source records attributed to C L Berseth.

At least 19 recordsLinked to original sources
PubMed2001

Feeding methods for the preterm infant.

As more very immature preterm infants survive, provision of enteral feedings has become a major focus of concern. Although many aspects of gastrointestinal function are immature in the preterm infant, the ability of the preterm neonate to process and absorb enteral nutrients appears to be adequate enough to sustain nutritional needs. Few prospective randomized trials have compared the efficacy of different feeding methods. However, some studies have compared differing routes of feeding, rates of feeding, and volume of feeding. The ability to successfully digest enteral feedings may be inhibited or enhanced by pharmacological agents. The need to modify a feeding strategy can be monitored by tracking several measurements prospectively. Finally, there is a need to assess ongoing dietary needs of preterm infants for discharge planning.

Digestion↗
PubMed2000

Mydriatics slow gastric emptying in preterm infants.

OBJECTIVE: Preterm infants are more likely to have episodes of abdominal distention, emesis, and gastric residuals 24 hours after their first screening examination for retinopathy of prematurity (ROP) than on the day preceding the examination. Because these feeding problems reflect abnormalities in motor function, the purpose of this study was to compare antral and duodenal motor activity and gastric emptying in preterm infants before and after the instillation of mydriatics. STUDY DESIGN: Using a low compliance continuous perfusion manometric system, we recorded antral and duodenal fasting motor activity in 11 preterm infants before and after the instillation of mydriatics for their first screening examination for ROP. Gastric emptying was compared before and after the eye examination. RESULTS: Although the number of antral motor contractions remained relatively constant throughout the study, duodenal motor contractions decreased nearly fourfold after the instillation of mydriatics versus that seen before (P <.01). Gastric emptying was significantly delayed after the completion of the eye examination compared with that seen before the examination (P <.05). CONCLUSION: Current doses of mydriatics inhibit duodenal motor activity and delay gastric emptying, and these gastrointestinal effects of mydriatics may underlie the feeding difficulties seen in preterm infants on the day of screening examinations for ROP.

Duodenum↗
PubMed2000

Enhanced growth of preterm infants fed a new powdered human milk fortifier: A randomized, controlled trial.

OBJECTIVE: A prospective, double-blind, randomized, controlled trial was conducted to evaluate the growth and nutritional status of preterm infants receiving preterm human milk supplemented with a newly formulated powdered human milk fortifier (HMF), study fortifier (SF), or a powdered commercial HMF (CF). METHODS: Infants (n = 144) with a birth weight </=1600 g and gestational age at birth of </=33 weeks were enrolled and randomized before 21 days of life. Study day (SDAY) 1 was defined as the day full-strength fortification (4 packets/100 mL) began and the infant reached an intake of at least 100 mL/kg/day. Growth, biochemical indices of nutritional status, enteral intake, feeding tolerance, clinical histories, and morbidity were assessed serially. The primary outcome variable was weight gain (g/kg/day) from SDAYs 1 to 29 or hospital discharge, whichever came first. RESULTS: Infants fed human milk supplemented with SF consistently grew more rapidly from SDAYs 1 to 29 (or hospital discharge), regardless of whether the statistical analyses were performed on all subjects who were randomized into the study and reached SDAY 1 (intent-to-treat) or were limited to those able to adhere strictly to the feeding protocol of the study (subgroup). Using mean values adjusted for study site (least square [LS] means), the weight gain differences were 2.6 and 3.8 g/kg/day for the intent-to-treat and subgroup analyses, respectively. Likewise, the length-gain differences were.14 and.18 cm/week for the intent-to-treat and subgroup analyses, respectively. Infants in the SF group reached a weight of 1800 g at SDAY 18, and those in the CF group at SDAY 25. Mean alkaline phosphatase values among infants in the SF group were higher than for the CF infants (eg, LS means: 327 U/L vs 272 U/L, intent-to-treat analysis), likely reflecting the more rapid linear growth of the SF infants. Mean serum calcium values tended to be lower in the SF group in the intent-to-treat analysis and were significantly lower in the subgroup analysis (LS means: 10.3 mg/dL vs 11.2 mg/dL). Both fortifiers were generally well-tolerated, although an increased number of infants in the CF group exited the feeding protocol because of gastric residuals and abdominal distention. CONCLUSION: A new powdered HMF was shown to enhance the growth of preterm infants, compared with a commercially available powdered HMF in the United States.

Anthropometry↗
PubMed1999

Health status of children with special health care needs: measurement issues and instruments.

The methods for measuring health care outcomes and monitoring the health status of the child with a chronic health condition must be available, accessible, and meaningful. This review was evoked by this need to identify reliable and valid instruments for measuring the health status of children with special health care needs. The objectives are as follows: (1) to review the methodologic and substantive issues related to the selection of instruments and (2) to identify those instruments available currently for collecting data regarding health status of children with special health care needs. A Medline search of the literature published since 1966 through 1998 and restricted to human subjects and the English language was conducted. Indexing terms included health status, quality of life, outcome assessment, functional status, and patient satisfaction. Multiple reviewers selected instruments based on their usefulness in clinical settings as generic, disease nonspecific, child health status instruments. Few instruments were identified that can be used by pediatricians for tracking and monitoring the health status of children with special health care needs. In conclusion, to progress in the field of outcomes measurement of children with special health care needs, it will be necessary to develop new measurement tools. These instruments must (1) provide valid and reliable information on health status; (2) be useful in guiding the management of patients; and (3) not be a burden for physicians, patients, or patient's families.

Adolescent↗
PubMed1999

Assessment in intestinal motility as a guide in the feeding management of the newborn.

Coordinated contractions of the gastrointestinal muscle layers mix ingested nutrients with secretions and propel unused nutrients forward for expulsion. Manometry is the technique of measuring pressure changes inside the gut lumen to indirectly measure the presence of contractions in the muscle layers. The types of gastrointestinal motor patterns seen in preterm infants differ from those seen in the adult. Characteristics of these patterns change with age and the way in which babies are fed. This technique has been useful in identifying better ways to feed preterm babies.

Gastrointestinal Motility↗
PubMed1998

Slow infusion feedings enhance duodenal motor responses and gastric emptying in preterm infants.

It is unknown whether it is better to feed preterm infants intragastrically by bolus or continuous infusion. This study compared the effect of 2 feeding rates on antral and duodenal motor responses and gastric emptying. Continuous perfusion manometry with a low-compliance machine was performed in 22 infants given feedings at 2 infusion rates. Gastric emptying was also assessed by using a dye-dilution technique to determine whether changes in motor response were reflected by changes in function. The number of antral contractions with both feeding rates decreased from that seen during fasting. Duodenal motor responses increased when infants were fed by slow infusion and decreased when they were fed by rapid infusion. Infants emptied 12 mL/kg of a 20-mL/kg feeding by 20 min after completion of the feeding given by slow infusion concomitantly with the increase in duodenal motor activity but only 8 mL/kg by 20 min after completion of the bolus feeding, when duodenal motor activity decreased (P < 0.01). Two hours after completion of the feeding, volumes remaining in the stomach after slow infusion were one-ninth those remaining after bolus feeding. When preterm infants are fed by slow infusion over 120 min, their duodenal motor responses are more like those observed in adults and their gastric contents are emptied faster and more completely than when they are fed with a rapid bolus.

Duodenum↗
PubMed1998

Actuarial survival in the premature infant less than 30 weeks' gestation.

OBJECTIVE: Because survival from admission to discharge does not provide parents and physicians information about future life expectancy in the premature neonate, we characterized the actuarial survival, defined as the future life expectancy from a given postnatal age, in a large inborn population of premature infants < 30 weeks' gestation. STUDY DESIGN: We determined daily actuarial survival of 1925 inborn infants (23 to 29 weeks' gestation) admitted to the Baylor Affiliated Nurseries from July 1986 through December 1994, stratified by 100-g birth weight and by 1-week gestational-age intervals. RESULTS: In the 501- to 600-g birth weight stratum, actuarial survival improved from 31% at birth, to 61% on day of life 7, and then to 75% on day of life 28; in the 901- to 1000-g birth weight stratum, actuarial survival improved from 88%, to 94%, and then to 98% throughout the same times, respectively. Similar trends were obtained when data were stratified by gestational age. CONCLUSIONS: Survival in the smallest infants improves dramatically during the first few days of life, but there is a significant risk for late death in the smallest of these infants.

Actuarial Analysis↗
PubMed1997

Regulation of migrating motor complexes by motilin and pancreatic polypeptide in human infants.

In adults, migrating motor complexes (MMCs) appear to be partially under hormonal modulation by motilin and pancreatic polypeptide. Preterm infants do not exhibit MMCs until 32 wk of gestation. Although plasma concentrations of motilin are similar in infants and adults, it is not known if actual hormonal modulation of MMCs is present in infants. In the first study we assessed whether plasma concentrations of motilin and pancreatic polypeptide surge with the occurrence of MMCs in term infants. In the second study we assessed whether erythromycin, a motilin receptor agonist, could induce migrating motor activity in preterm and term infants. In the first study we recorded motor activity in nine term infants who had never been fed. We determined plasma concentrations of motilin and pancreatic polypeptide in the presence and absence of MMCs. In the second study we gave the motilin agonist erythromycin intragastrically to 21 infants at a range of 24-42 wk of gestation to assess whether migrating activity could be induced via the motilin receptor. In the first study, plasma concentrations of motilin were similar during the presence and absence of MMCs, as were plasma concentrations of pancreatic polypeptide. In the second study, the administration of erythromycin induced the appearance of migrating activity in 7 of 14 infants who were older than 32 wk but in none of the infants who was younger than 32 wk. Although the motilin receptor appears to be functionally present beyond 32 wk of gestation, as assessed by in indirect pharmacologic challenge, hormonal modulation of migrating activity in the neonate by plasma motilin and pancreatic polypeptide is absent.

Anti-Bacterial Agents↗
PubMed1997

Duodenal motor responses in preterm infants fed formula with varying concentrations and rates of infusion.

Feeding intolerance is frequently reflected in preterm infants by delayed gastric emptying. Gastric emptying is delayed by the physical characteristics of ingested nutrient as well as the rate of feeding. Because gastric emptying is dependent upon duodenal function, the present studies were undertaken to assess duodenal motor responses to feeding of differing nutrient content and rate of feeding. Using a Latin square design we recorded duodenal motor responses in 14 preterm infants given four test feedings in random order over 18 h. Three were given as a 120-min infusion containing no nutrient, a 10 cal/oz formula, and a 20 cal/oz formula. The fourth test feeding consisted of a 20 cal/oz formula given as a bolus over 15 min. Although caloric density was altered, osmotic load and nutrient proportions of the formulas were not. Motor responses were recorded using a low compliance continuous perfusion manometric system. When infants were fed "water" and half-strength formula as a slow infusion, they demonstrated little or no duodenal motor response to feeding. When these infants were fed full-strength formula as a slow infusion, they displayed a brisk increase in motor activity (p < 0.05), but profound motor quiescence when fed the same volume by bolus over 15 min (p < 0.05). Of the four test feedings, only full-strength formula given as a slow infusion triggered adult-like duodenal motor responses to feeding. We speculate that feedings of full-strength formula given slowly by infusion will improve feeding tolerance.

Duodenum↗
PubMed1996

Gestational and postnatal maturation of duodenal motor responses to intragastric feeding.

OBJECTIVE: Continuous perfusion manometry was performed in 93 preterm and 14 term infants, none of whom had ever been fed enterally, to determine whether duodenal motor responses to bolus feeding differ in preterm and term infants. STUDY DESIGN: Motor activity was recorded for 6 hours: 4 hours before and 2 hours after an intragastric feeding composed of Similac Special Care Formula, 5 ml/kg, infused for 15 minutes. RESULTS: Although 12 of 14 term infants had an increase in duodenal motor activity postprandially, similar to that seen in adults (i.e., a mature fed response), only 32 of the 93 preterm infants did (chi square statistic = 13.2; p < 0.001). In contrast to these infants, 2 term and 77 preterm infants had a decrease in duodenal motor activity (i.e., an immature fed response). There was a significant increase in the number of peaks per 30 minutes in the postprandial recordings of infants who demonstrated the "mature fed response" and a significant decrease in the number of peaks per 30 minutes in the postprandial recordings of infants who had an "immature fed response" (all p < 0.05). We then reevaluated motor responses to feeding among 41 of the preterm infants after they had received small enteral feedings of 24 ml/kg per day for 7 to 10 days. Although 11 of these infants had exhibited a mature response at the time of their initial study, 25 did at the time of the second study (p < 0.03). CONCLUSION: The duodenal motor response to bolus feeding differs in preterm and term infants; however, with enteral feeding experience, preterm infants begin to demonstrate more mature duodenal motor responses to feeding.

Birth Weight↗
PubMed1996

Neither motor responses nor gastric emptying vary in response to formula temperature in preterm infants.

The purpose of this study was to assess gastrointestinal responses to formula temperature in preterm infants. Healthy preterm infants were fed 4,250 KJ/l formula at 6, 24, and 37 degrees C. There was no significant difference in the magnitude of antral or duodenal motor responses among the three temperatures. All infants emptied approximately one third of the bolus feeding by 20 min, but there was no difference among the temperatures. Approximately 10-20% of a bolus feeding remained in the stomach 2 h postprandially, but there was no difference among the temperatures. Thermoreceptors do not appear to be functionally present in the preterm infant, suggesting that the benefit of feeding warmed formula to the preterm infant my have a limited physiological value.

Gastric Emptying↗
PubMed1996

Gastrointestinal motility in the neonate.

Many aspects of the forward propulsion of enteral nutrients are not fully mature in the preterm and term neonate. Because the regulation of motor activity in the gastrointestinal tract is complex and multifaceted, many levels of regulation of this activity are immature in the preterm infant; however, as neonatologists develop a better understanding of the physiologic mechanisms that underlie these dysfunctions as well as the interactions of nutrients, hormones, and pharmacologic agents with these regulatory mechanisms, better feeding strategies can be tailored for these infants. Moreover, current studies will permit the development of predictive and diagnostic tools as well as the refinement of pharmacologic interventions for these infants.

Feeding Behavior↗
PubMed1995

Postnatal change in inhibitory regulation of intestinal motor activity in human and canine neonates.

Motor activity was recorded in 19 preterm infants three times during the first postnatal month. There was a paucity of small intestinal motor quiescence during fasting in the first postnatal week; however, its duration significantly increased with postnatal age (p < 0.03). Although fasting motor patterns changed with postnatal age, motor responses to feeding were present within the first few days of life. Motor activity was also recorded weekly in 11 newborn dogs for 6 wk. Intestinal motor quiescence was also absent during fasting for the first postnatal week but it significantly increased with postnatal age (p < 0.002). As in the human preterm infant, a motor response to feeding was present within the first few days of life. Plasma concentrations of gastrin and peptide YY during fasting were low in the preterm human and canine neonate during the first postnatal week but plasma concentrations of both peptides increased with postnatal age. Although plasma concentrations of gastrin were low during fasting for the first postnatal week, plasma concentrations of gastrin increased significantly postprandially compared with fasting (p < 0.05). We conclude that motor quiescence during fasting becomes a more prominent feature of newborn intestinal motor function postnatally. In addition the release of two peptides that regulate motor patterns also change postnatally. Thus, postnatal changes in motor patterns and peptide release change in a parallel fashion in human preterm neonates and canine neonates.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Acute and chronic intestinal motor activity responses to two infant formulas.

OBJECTIVE: Preterm formulas are nutritionally better for preterm infants; however, it has been observed that these formulas cause more feeding intolerance than do regular formulas. Because intestinal motor activity is responsible for the aboral movement of intraluminal nutrients, the purpose of this study was to evaluate intestinal motor activity responses to two infant formulas: 84 and 100.8 J/oz. STUDY DESIGN AND RESULTS: Intestinal motor activity was recorded in 52 preterm infants who had never been fed and who were randomly assigned to receive small enteral feedings (24 mL/kg per day) for 10 days with one of two commonly used infant formulas. In a subset of 26 of these infants, acute motor responses to both formulas were also evaluated. At the end of the study period, motor activity during fasting did not differ between the two groups of infants. However, motor responses during feeding to the two formulas differed significantly. When infants were fed for the first time, their motor activity increased compared with fasting when they were fed the 84-J/oz formula but decreased when they were fed the 100.8-J/oz formula. These differences in motor responses to the two formulas were not present 10 days later. These differences in motor responses to the 100.8- and 84-J/oz formulas were even more pronounced among the 7 infants who subsequently developed feeding intolerance to the 100.8-J/oz formula during the 10-day study period. CONCLUSION: Inhibition of motor responses to calorically denser formulas during active feeding in a subset of preterm infants may underlie the feeding intolerance they experience when they are fed these formulas. However, this inhibitory response diminishes with age, suggesting that denser formulas can be reintroduced later in life to these infants.

Aging↗
PubMed1995

Minimal enteral feedings.

The provision of early minimal enteral nutrition to the metabolically stable premature infant appears to result in multiple nutritional benefits and in a minimal risk of complications. Whereas benefits can be achieved with feeding volumes ranging from 0.1 to 4 mL/kg, future studies will need to address the responses of the immune system, the circulatory system, and motor activity of the intestine to various feeding regimens before pragmatic recommendations can be concluded.

Blood Circulation↗
PubMed1995

Manometrics for preterm and term infants: a new tool for old questions.

OBJECTIVE: The purpose of this study was to use low-compliance, continuous-perfusion manometry to assess motor activity responses of preterm and term infants to three different methods of feeding commonly used in neonatal intensive care units. METHODS: All 48 infants who participated in this study were assigned to one of three feeding trials using a 20-calorie/oz formula. Trial 1 varied the mode of feeding, trial 2 varied the volume of feeding, and trial 3 varied the concentration of feeding. RESULTS: In trial 1, small intestinal motor activity changed similarly and significantly in response to intragastric (P < .005) and transpyloric feeding (P < .02). In trial 2, feeding containing a small volume (4 mL/kg) and a larger volume (10 mL/kg) elicited significant changes in motor activity compared to that seen during fasting (P < .005). In trial 3, motor activity differed in response to varying caloric density. Motor activity failed to change in response to feedings that contained one-third-concentration formula, but it did change in response to the feedings that contained two-thirds- and full-concentration formula (P < .02). Furthermore, the onset of the motor response to feeding was inversely related to the concentration of formula (P < .01), and the duration of the fed response also was related to the concentration of formula (P < .01). CONCLUSIONS: Gastric and transpyloric feedings are equally potent in eliciting an intestinal motor response to feeding. Furthermore, a volume as small as 4 mL/kg is sufficient to elicit such a response. However, preterm intestinal motility responses are affected significantly by changes in the caloric density of formula, suggesting that diluted formula may not provide an optimal stimulant for the preterm intestinal functional responses to feeding.

Energy Intake↗
PubMed1994

Gut motility and the pathogenesis of necrotizing enterocolitis.

Forward movement of intestinal nutrients is achieved by motor activity. Motor activity patterns are "abnormal" in adults as well as preterm infants who display intolerance to enteral feedings. Manometrics can be used diagnostically and prospectively to identify infants at risk for feeding intolerance.

Adult↗