Enteral Feeding and Necrotizing Enterocolitis: Does Time of First Feeds and Rate of Advancement Matter?

Abstract

Objective: The aim of the study was to determine if time to initial enteral feeding (EF) and rate of advancement are associated with necrotizing enterocolitis (NEC) or death. Methods: Secondary analysis of prospectively collected data of very-lowbirth-weight infants (VLBWI: 400-1500 g) born in 26 NEOCOSUR centers between 2000 and 2014. Results: Among 12,387 VLBWI, 83.7% survived without NEC, 6.6% developed NEC and survived, and 9.6% had NEC and died or died without NEC (NEC/death). After risk adjustment, time to initial EF (median ¼ 2 days) was not associated with NEC; however, delaying it was protective for NEC/death (odds ratio [OR] ¼ 0.96; 95% confidence interval [CI] 0.93-0.99). A slower feeding advancement rate (FAR) was protective for NEC (OR ¼ 0.97; 95% CI ¼ 0.94-0.98) and for NEC/death (OR ¼ 0.98; 95% CI ¼ 0.96-0.99). Conclusions: In VLBWI, there was no association between an early initial EF and NEC, although delaying it was associated with less NEC/death. A slower FAR was associated with lower risk of both outcomes.

Newborn risk factors of necrotizing enterocolitis in developing countries: A literature review

“…Suspending trophic feeding was associated with less NEC cases and NEC related death. [19] Findings in this study describes neonates who started trophic feeding had 5.89 times more likely to acquire NEC. Length of hospitalization was notably linked with NEC contributing of 3.28 times higher chances of acquiring NEC compared to neonates with less than a week length of stay in this study.…”

Necrotizing Enterocolitis and Its Predictors Among Preterm Neonates Admitted in Neonatal Intensive Care Units of Gurage Zone Public Hospitals, Southwest Ethiopia, 2021

“…Initiation of trophic feeding was associated with an increase in the risk of developing NEC, and it was evidenced by findings from a referral and training center in East Azerbaijan Province of Islamic Republic of Iran, 37 , 38 in which delaying initiation was associated with less NEC and NEC associated death.…”

Necrotising enterocolitis in a middle‐income country: Early onset and risk factors for mortality

“…also found a predominance of early‐onset NEC occurring at a median age of 6 days. This may be due to rapid advancement of enteral feeds or an increased exposure to formula milk 23 . A Cochrane review (2021) showed slow advancement of feeds had no protective effect against NEC, but did not comment on timing 24 .…”