Influences of Feeding on Necrotizing Enterocolitis

Abstract

Despite the recognition that enteral feeding and some clinical conditions encountered during the management of prematurity may affect the development of necrotizing enterocolitis (NEC) in premature neonates, there is still significant variation in practice. Clinicians should be aware of the current evidence regarding feeding and the development of NEC in premature neonates, specifically relating to the use of breast milk, feeding when a patent ductus arteriosus is present and during its treatment, as well as the potential association of NEC with anemia and red blood cell transfusions. AbstractNecrotizing enterocolitis (NEC) remains one of the leading complications of prematurity with an incidence of 5% to 13% and a mortality of up to 30%. Its occurrence is inversely related to gestational age, with the most premature neonates being at highest risk. Despite numerous studies assessing risk factors, the most commonly observed associations remain prematurity and enteral feeding. Furthermore, studies have pointed to receipt of breast milk as a protective factor in decreasing the risk of NEC and formula feeding as potentially increasing the risk. Other potential risk factors and associations in the premature infant include lack of antenatal steroids, receipt of prolonged courses of postnatal antibiotics, presence of anemia, receipt of packed red blood cell transfusions, and presence of a patent ductus arteriosus. Despite the recognition that NEC remains a serious complication of prematurity, there is still no specific prescription for its prevention. Given that enteral feeding is one of the most commonly observed risk factors for the development of NEC, wide variation exists in the enteral feeding recommendations and practices for premature infants. Feeding practices that may contribute to NEC, which remain variable in practice, include feeding strategies used in the presence of a hemodynamically significant patent ductus arteriosus and feeding during packed red blood cell transfusions. Use of breast milk (mother's own milk or donor milk) is recognized as one of the mainstays of NEC prevention. This article explores multiple influences of feeding on the development of NEC.

Estimating Neonatal Necrotizing Enterocolitis Based on Feeding Practices

“…Feeding preterm neonates is still controversial; in some cases, enteral feeding appears to protect against the onset of NEC, and in others, it promotes changes that may contribute to the disease [ 3 ], although several guidelines have been published for VLBW infants [ 3 , 4 ].…”

“…Despite multiple studies evaluating its risk factors, the most commonly observed associations continue to be prematurity, enteral feeding, and infection [ 2 ]. Several studies have repeatedly shown that maternal milk (MM) offers a protective effect from developing NEC compared to infant formula milk (FM) [ 3 , 4 ]. Experts have recommended MM as the choice of feeding preterm infants, followed by pasteurized donor maternal milk (DM) and FM designed for preterm infants, and they have approved the use of human- or bovine-based milk fortifiers to meet their high nutrient needs [ 4 , 5 , 6 , 7 ].…”

“…Experts have recommended MM as the choice of feeding preterm infants, followed by pasteurized donor maternal milk (DM) and FM designed for preterm infants, and they have approved the use of human- or bovine-based milk fortifiers to meet their high nutrient needs [ 4 , 5 , 6 , 7 ]. However, there is insufficient evidence regarding the effect of fortification of milk on NEC development, with little or no effect for protection from this disease [ 3 , 4 , 8 , 9 ].…”