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Simulated Amniotic Fluid-Like Solution Enterally Given to Neonates after Obstructive Bowel Surgeries: A Randomized Controlled Trial

El-Farrash, Rania Ali, Gad, Ghada Ibrahim, Abdelkader, Hesham Mohammed, Salem, Dalia Ahmed Diaael-Dine, Fahmy, Safaa AbdElaziz
Nutrition 2019
amniotic fluid, atrophy, congenital abnormalities, energy intake, enteral feeding, erythropoietin, gestational age, granulocyte colony-stimulating factor, intestines, neonates, placebos, randomized clinical trials, surgery, total parenteral nutrition, weight gain
Withholding postoperative feeding is common among neonates recovering from surgeries for congenital abnormalities of the gastrointestinal tract (GIT) which leads to prolonged exposure to total parenteral nutrition, intestinal atrophy, and feeding intolerance. Since amniotic fluid plays a significant role in the fetal gut maturation and development, we conducted this study to test a hypothesis suggesting that feeding tolerance could be improved in neonates recovering from surgeries for congenital obstructive bowel abnormalities by enteral administration of Simulated Amniotic Fluid-like solution (SAFE) containing recombinant human granulocyte colony stimulating factor (rh G-CSF) and erythropoietin (rh-EPO).This prospective double-blinded randomized placebo-controlled trial was conducted on 40 late preterm/term neonates recovering from GIT surgeries. Neonates were randomly divided postoperatively into 2 groups: 20 neonates received the test solution (SAFE group) and 20 neonates received distilled water (placebo group) with a gestational age range (34.3 - 40.4 vs 34 - 40 weeks respectively) and mean gestational age (37.10±1.68 vs 36.90±1.83 weeks respectively). Treatment was started postoperatively and the test solution (or distilled water) was discontinued when enteral intake reached 100 mL/kg/day.The study group showed better feeding tolerance as reflected by an earlier achievement of 50, 100, 120, and 150 mL/kg/day enteral feeding with a higher enteral caloric intake on day 7 post SAFE administration and a higher rate of weight gain (p<0.05 for all).Enteral administration of simulated amniotic fluid-like solution may improve postoperative feeding tolerance, enteral caloric intake, and weight gain. This trial was registered in; identifier: NCT03302338.