Turkiye Klinikleri Journal of Pediatrics

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Preterm Bebeklerde Dirençli Beslenme İntoleransında Amino Asit Bazlı Formüla Kurtarma Tedavisi Olabilir mi?
Can the Amino Acid-Based Formula Be the Rescue Therapy for Resistant Feeding Intolerance in Preterm Infants?
Tuğba BARSAN KAYAa, Özge SÜRMELİ ONAYa, Özge AYDEMİRa, Neslihan TEKİNa
aEskişehir Osmangazi Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları ABD, Eskişehir, TÜRKİYE
Turkiye Klinikleri J Pediatr. 2021;30(1):91-8
doi: 10.5336/pediatr.2020-75436
Article Language: TR
Full Text
ÖZET
 Beslenme intoleransı özellikle preterm bebeklerde görülen gastrik rezidü, abdominal distansiyon ve/veya kusma ile kendini gösteren, sıklıkla beslenme planının değişmesine neden olan sindirim bozukluğudur. Amino asit bazlı formüla (ABF)larda protein amino asitlere kadar parçalanmıştır, alerjenitesi çok düşüktür ve kolay absorbe olur. Bu olgu serisinde Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Yenidoğan Yoğun Bakım Ünitesinde 2018-2019 yılları arasında dirençli beslenme intoleransı nedeniyle ABF ile beslenen 5 olgu değerlendirilmiştir. Minimal enteral beslenmeyi dâhi tolere edemeyen, çok düşük ve aşırı düşük doğum ağırlıklı preterm bebeklerde, geçici süre ile ABF kullanımı enteral beslenmenin kademeli artırılarak tam enteral beslenmeye geçişini sağlamıştır. ABF kullanımı sonrasında parenteral beslenme süresinin kısaldığı, günlük kilo alım hızının arttığı ve sepsis atak sayısının azaldığı gözlemlenmiştir. Preterm bebeklerde enteral beslenmenin toleransı gastrointestinal sistemin maturasyon (motilite, enzimatik sindirim, hormonal yanıt, bakteriyal kolonizasyon, lokal immunite) derecesine bağlıdır. Tam enteral beslenmeye geçiş sonrası tekrar anne sütü ile beslenmeye devam edilebilmesi nedeniyle bu geçici durumun patofizyolojisinde protein alerjisinden farklı olarak enzimatik immatüritenin olduğu düşünülmüştür.

Anahtar Kelimeler: Beslenme intoleransı; amino asit bazlı formüla; preterm
ABSTRACT
 Feeding intolerance is a digestive disorder that occurs especially in preterm infants with gastric residual, abdominal distension and/or vomiting, often causes changes in the diet plan. In aminoacid-based formula (AAF), the protein is broken down to aminoacids, its allergenicity is very low and it is easily absorbed. In this case series, five cases with AAF a were evaluated in Eskişehir University Faculty of Medicine Neonatal Care Unit between 2018- 2019. The temporary use of AAF through gradual increase of nutrition in preterm infants with very low birth weight, who could not tolerate even minimal enteral nutrition, led to the transition to full enteral nutrition. After the use of AAF, we experienced shorter parenteral feeding time, increased daily weight gain rate, decreased number of sepsis attacks. The tolerance of enteral nutrition in preterm infants depends on the degree of maturation (motility, enzymatic digestion, hormonal response, bacterial colonization, local immunity) of the gastrointestinal system. Since it can continue to be fed again with breast milk after the transition to full enteral nutrition, it was thought that, different from the protein allergy, it is enzymatic immaturity in the pathophysiology of this transient condition.

Keywords: Feeding intolerance; aminoacid-based formula; preterm
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