Current Practices, Challenges, and Recommendations in Enteral Nutrition After Necrotizing Enterocolitis

Itriago, Elena; Trahan, K Fernandez; Massieu, L. Adriana; Garg, Parvesh Mohan; Premkumar, Muralidhar H.

doi:10.1016/j.clp.2023.04.009

Cited by 3 publications

(5 citation statements)

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“…The resumption of feeding preterm neonates after surgery is a minefield where the duration of fasting and the type of feeding can have both advantages and disadvantages. Clearly, the consequences of delayed enteral feeding include oral aversion, gastrointestinal effects (mucosal villous atrophy, dysbiosis, small bowel bacterial overgrowth, and intestinal dysmotility), dependence on parenteral nutrition, and intestinal failure-associated liver disease, as well as a higher risk of bloodstream infections due to the prolonged indwelling time of central venous catheters [ 32 , 33 ].…”

Section: Early Enteral Feeding and Fast Advancementmentioning

confidence: 99%

“…After medically treated NEC, there is no correlation between early enteral feeding resumed within 5–7 days after NEC diagnosis and a higher risk of unfavorable outcomes, including recurrent NEC or post-NEC strictures [ 35 , 36 ]. The cornerstones of post-NEC nutrition, therefore, include a careful assessment of the patient’s feeding tolerance, an individualized recognition of feeding tolerance, and a reduction in periods of intestinal rest and antibiotic exposure [ 32 ]. However, to date, there are no randomized controlled trials comparing different periods of bowel rest to determine the optimal duration.…”

Section: Early Enteral Feeding and Fast Advancementmentioning

confidence: 99%

“…However, to date, there are no randomized controlled trials comparing different periods of bowel rest to determine the optimal duration. The practice recently suggested by several authors is to resume enteral feeding early (5–7 days) after the clinical and radiological signs of NEC have resolved [ 32 , 37 ].…”

Section: Early Enteral Feeding and Fast Advancementmentioning

confidence: 99%

“…For refeeding neonates after NEC, when human milk is unavailable, some neonatologists prescribe preterm formula, while others prescribe extensively hydrolyzed formula (EHF) [ 32 ]. If the gastrointestinal tract is severely damaged, elemental or lactose-free amino acid-based infant formulas with variable levels of medium-chain triglycerides can also be used due to malabsorption.…”

Section: The Crucial Role Of Human Milkmentioning

confidence: 99%

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Nutritional Strategies for Preterm Neonates and Preterm Neonates Undergoing Surgery: New Insights for Practice and Wrong Beliefs to Uproot

De Rose,

Lapillonne,

Iacobelli

et al. 2024

Nutrients

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The nutrition of preterm infants remains contaminated by wrong beliefs that reflect inexactitudes and perpetuate old practices. In this narrative review, we report current evidence in preterm neonates and in preterm neonates undergoing surgery. Convictions that necrotizing enterocolitis is reduced by the delay in introducing enteral feeding, a slow advancement in enteral feeds, and the systematic control of residual gastric volumes, should be abandoned. On the contrary, these practices prolong the time to reach full enteral feeding. The length of parenteral nutrition should be as short as possible to reduce the infectious risk. Intrauterine growth restriction, hemodynamic and respiratory instability, and patent ductus arteriosus should be considered in advancing enteral feeds, but they must not translate into prolonged fasting, which can be equally dangerous. Clinicians should also keep in mind the risk of refeeding syndrome in case of high amino acid intake and inadequate electrolyte supply, closely monitoring them. Conversely, when preterm infants undergo surgery, nutritional strategies are still based on retrospective studies and opinions rather than on randomized controlled trials. Finally, this review also highlights how the use of adequately fortified human milk is strongly recommended, as it offers unique benefits for immune and gastrointestinal health and neurodevelopmental outcomes.

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Section: Early Enteral Feeding and Fast Advancementmentioning

confidence: 99%

Section: Early Enteral Feeding and Fast Advancementmentioning

confidence: 99%

Section: Early Enteral Feeding and Fast Advancementmentioning

confidence: 99%

Section: The Crucial Role Of Human Milkmentioning

confidence: 99%

See 2 more Smart Citations

Nutritional Strategies for Preterm Neonates and Preterm Neonates Undergoing Surgery: New Insights for Practice and Wrong Beliefs to Uproot

De Rose,

Lapillonne,

Iacobelli

et al. 2024

Nutrients

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“…При тяжёлом течении послеоперационного периода у больных раннего возраста, находящихся на длительной ИВЛ, инфузиях морфина и миорелаксантов, с признаками анасарки интерпретация рентгеновской картины и клиники острой хирургической патологии в брюшной полости может быть затруднена. У этих больных в послеоперационном периоде следует использовать систему коррекции питания и нарушений микробиоты кишечника с использованием современных рекомендаций для эффективной профилактики НЭК [39][40][41].…”

Section: заключениеunclassified

Features of the formation of necrotizing enterocolitis in cardiac surgery children patients

Sarsenbayeva,

Kim,

Berdibekov

2023

RPJ

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of the gastrointestinal tract (GIT) in patients. Necrotizing enterocolitis (NEC) remains the most complex and least studied problem in pediatrics, including cardiac surgery. In pediatric cardiac surgery, the decrease in perfusion of the internal organs of the abdominal cavity is due to low perfusion pressure during cardiopulmonary bypass, low cardiac output in the postoperative period, aggravation of sympathetic vasoconstriction due to the stress response to surgery, and the introduction of exogenous catecholamines. Objective: analysis of the features of the development of NEC in cardiac surgery children patients. Materials and methods. A prospective analysis of thirty cardiac surgery children patients with the development of gastrointestinal dysfunction after surgery was performed. All children underwent standard research methods. Results. In 63.3% of cases, children showed signs of dynamic intestinal obstruction; 36.7% of newborns have signs of necrotizing enterocolitis of varying degrees. The features of the bacteriological landscape, clinical manifestations and X-ray picture depending on the type of intestinal function disorder are presented. The role of hypoxia, hypoperfusion during cardiopulmonary bypass, the functioning of the open ductus arteriosus in “blue” patients in the formation of the risks of developing necrotizing enterocolitis is shown. Among the studied patients, according to the age structure, there were newborns — 18 (60%) patients, children under 6 months — 10 (33,3%); older than 1 year — 2 (96,6%). An analysis of clinical manifestations in children in the preoperative and postoperative periods showed 19 cases (63.3%) to have signs of dynamic intestinal obstruction. This group of children consisted of 8 newborns (36.8%) and 12 patients of the postnatal period. All patients were after heart surgery (2 patients after narrowing of the pulmonary artery and 10 cases cc were operated on under cardiopulmonary bypass). The most difficult and severe group of patients after heart and vascular surgery were children with congenital heart defects, who developed signs of NEC — 11 patients (36.6%). 10 children were neonates, 1 patient was ovet 5 years. It is shown that the development of such complications including infectious and hypoxic causes, heart failure, the duration of cardiopulmonary bypass and diastolic stealing of vessels is of decisive importance. Conclusions. Dysfunction of the gastrointestinal tract after heart surgery in children is one of the urgent problems of cardiac surgery. In the group of severe sick patients undergoing prolonged ventilation, morphine infusion, muscle relaxants, with signs of anasarca, the interpretation of the X-ray picture and the clinic of acute surgical pathology in the abdominal cavity may be difficult. NEC, occurred in newborns over the postoperative period, is often not recognized in a timely manner and leads to an unfavourable outcome.

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Nutritional management after necrotizing enterocolitis and focal intestinal perforation in preterm infants

Mo,

Lapillonne,

van den Akker

et al. 2024

Pediatr Res

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Current Practices, Challenges, and Recommendations in Enteral Nutrition After Necrotizing Enterocolitis

Cited by 3 publications

References 65 publications

Nutritional Strategies for Preterm Neonates and Preterm Neonates Undergoing Surgery: New Insights for Practice and Wrong Beliefs to Uproot

Nutritional Strategies for Preterm Neonates and Preterm Neonates Undergoing Surgery: New Insights for Practice and Wrong Beliefs to Uproot

Features of the formation of necrotizing enterocolitis in cardiac surgery children patients

Nutritional management after necrotizing enterocolitis and focal intestinal perforation in preterm infants

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