Does chronic prenatal Doppler pathology predict feeding difficulties in neonates?

Aim: To determine whether infants with compromised fetomaternal circulation, but not yet critically threatened by absent end-diastolic flow velocities in the umbilical arteries, are at a risk for feeding problems. Methods: In a retrospective case-control study, enteral feeding and clinical data were compared between infants with decreased prenatal end-diastolic umbilical flow velocity (DEDFV) or brain-sparing pathology and controls matched for gestational age (GA). In all infants, enteral feedings were advanced according to a standardized enteral feeding protocol. Results: 11 (GA > 34 wk) of the 87 infants with DEDFV were fully enterally fed by day 5 and excluded, leaving 76 infants (and matched controls) for final analysis. DEDFV infants were significantly smaller (1230 +/- 550 g vs 1600 +/- 682 g). Advancement of enteral feedings varied widely, with a significant difference between DEDFV infants and controls. There was no difference in the incidence of NEC ( five in both groups). In the most severely affected subgroup of 25 infants with GA < 30 wk and prenatal brain sparing, enteral feedings were significantly delayed in comparison to the controls (parenteral amino acid administration for 22 vs 15 d; significantly fewer enteral calories through day 15). Conclusion: Enteral feeds were introduced more slowly to infants who had shown signs of prenatal distress with brain sparing. However, a predisposition to NEC could not be proven. Our results thus do not support the delay of enteral feedings based on prenatal Doppler pathology.