Estimating Neonatal Necrotizing Enterocolitis Based on Feeding Practices

Abstract

(1) Background: The relationship between enteral nutrition and neonatal necrotizing enterocolitis (NEC) among premature neonates is still unclear. The present work was designed to assess the relationship between NEC and feeding strategies compared to control infants. (2) Methods: A retrospective case-control study of premature infants (<35 weeks’ gestation) with or without NEC that examined feeding practices and clinical characteristics at birth and 3, 7, and 14-day hospitalization, with a longitudinal and cross-sectional analysis. (3) Results: A total of 100 newborns with NEC diagnosis and 92 neonates without the disease with similar demographic and clinical characteristics were included. The median day of NEC diagnosis was 15 days (Interquartile Range (IQR) 5–25 days). A significantly higher number of neonates that were fasting on days 7 and 14 developed NEC (p < 0.05). In the longitudinal analysis, generalized linear and mixed models were fit to evaluate NEC association with feeding strategies and showed that exclusive mother’s own milk (MM) and fortified human milk (FHM) across time were significantly less likely associated with NEC (p < 0.001) and that enteral fasting was positively related with NEC. In the cross-sectional analysis, a binary logistic regression model was fit and predicted 80.7% of NEC cases. MM was also found to correlate with a reduced risk for NEC (OR 0.148, 95% CI 0.044–0.05, p = 0.02), and in particular, on day 14, several factors were related to a decreased odd for NEC, including birth weight, antenatal steroids, and the use of FHM (p < 0.001). (4) Conclusions: MM and FHM were associated with less NEC compared to fasting on days 7 and 14. Feeding practices in Neonatal Intensive Care Units (NICUs) should promote exclusive MM across the two-week critical period as a potential guideline to improve NEC outcome.

A prospective evaluation of the risk factors and utility of GutCheckNEC scoring system to predict necrotizing enterocolitis in preterm newborns, in a tertiary care centre in North India

“…Studies have shown a significant association between birth weight and risk of development of NEC. 17,18 Even in our study, the birth weight was lower in children who developed NEC (mean birth weight -1193 vs 1162 gms); however the difference was not statistically significant. 5-minute Apgar scores of <7 is was reported as a significant factor for the development of NEC, 17,19 however none of the cases in the current study had lower APGAR score or other features of perinatal asphyxia.…”

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

“…There is evidence that low birth weight increases the morbidity and mortality of neonates with NEC, 27–29 Sweden, 30 recent advance evidence, 31 systemic review evidence, 32 , 33 Seoul National University Bundang Hospital, Seongnam, Korea, 24 Mexico. 34 …”

Influence of maternal and perinatal factors on macronutrient content of very preterm human milk during the first weeks after birth

“…Around 50% of growth in very premature infants (VPI) is estimated to depend on nutritional support [2]. Following an initial period of parenteral nutrition, enteral feeding is provided as milk, with Mother´s Own Milk (MOM) as the best option [3], due to its strong association with a reduction in the incidence of some prematurity-related diseases (such as necrotizing entercolitis), and with a more favourable neurodevelopmental outcome [4][5][6] both of which might be related to an array of bioactive factors [7]. The last published guidance for enteral nutrition in preterm infants by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) [8] recommends an intake of 110-135 kcal/kg/day with between 3.5 and 4.0 (for patients weighing 1000-1800 g) and 4.0-4.5 g/kg/day (if under 1000 g) of protein.…”