Assessment of enteral nutrition in preterm newborns with patent ductus arteriosus under medical treatment

Objective: Patent ductus arteriosus (PDA) is the most common cardiovascular disorder in the preterm newborn population. It causes a decrease in organ perfusion. Hypoperfusion caused by the ductus has been clinically associated with necrotizing enterocolitis, cerebral ischemia, intraventricular hemorrhage, and pulmonary hemorrhage in newborns. Different practices for enteral nutrition have been reported during medical closure treatment due to the existing side effects of PDA and drug effects. However, studies cannot agree on a final result. In our study, it was aimed to analyze the effects of enteral nutrition during treatment in preterm infants under thirty two weeks with patent ductus arteriosus of medical treatment. Materials and Methods: Our study is retrospective. This study includes preterm infants below 32 weeks, born between 01/09/2019 and 31/12/2021 in Ankara City Hospital Pediatrics and Newborn Clinic and treated for patent ductus arteriosus. Patients were divided into three groups according to their nutritional conditions during treatment: A: never fed, B: <60ml/kg/g fed, and C: ≥60ml/kg/g fed. Demographic and antenatal characteristics of the patients, medical/surgical treatments for PDA, GIS intolerance, daily weight gain, duration to reach full enteral nutrition, duration to reach birth weight, duration to total parenteral nutrition intake, presence of gastrointestinal system bleeding, duration of discharge, kidney function tests disorder, thrombocytopenia, pulmonary hemorrhage, inotrope use, oxygen and mechanical ventilation duration, NEC (stage ≥2), surgical NEC, RDS, BPD, ROP, IVH, sepsis, and death results were recorded. The effects of nutrition during treatment, side effects of drug and neonatal morbidities were compared in patients through appropriate statistical analysis. Findings: When all patients were evaluated, GIS intolerance was found higher in the group that was never fed (p<0.05). The duration to reach full enteral nutrition was the longest in group A (p<0.05). The duration to reach birth weight was higher in group C (p<0.05). Daily weight gain was found least in group A (p<0.05). In terms of neonatal morbidities, mortality was higher in the group that was never fed (p<0.05). ROP and oxygen duration were determined the most in the group fed the most. When evaluated according to the medical treatment applied, GIS intolerance was found to be the least in group C in patients using ibuprofen (p<0.05). In patients who received ibuprofen+ paracetamol, NEC within seven days was higher in the low-fed group and a statistically significant difference was seen (p<0.05). There was no significant difference between the gastrointestinal problems and drug side effects related to nutrition in patients taking paracetamol. Conclusion: We think that enteral nutrition is beneficial in preterm patients who receive medical treatment for PDA and does not lead to an GIS and neonatal morbidities. Our study contributes to the literature in this aspect. Due to the small number of patients, more and extensive studies are still necessary. Keywords: Patent Ductus Arteriosus (PDA), Medical Treatment, Enteral Feeding, Gastrointestinal System