Optimizing Nutritional Strategies in Term NEC and Perforation Infants after Intestinal Perforation: A Retrospective Study

Abstract

Necrotizing enterocolitis (NEC) is a devastating disease in infants, and perforation is one of the most serious pathological manifestations. However, guidelines on how to refeed infants recovering from perforation after NEC are lacking. This study aimed to define which method of refeeding is better for NEC and perforation term-infants. The study included three sections: time to restart enteral nutrition (EN), advancement of EN, and type of restart feeding. Ninety full-term neonates developed perforation after NEC and underwent surgery were included. These samples were divided into EEN (< 7 days) and LEN (≥ 7 days) groups for the time to restart EN, FI (≥ 20 ml/kg/d) and SI (< 20 ml/kg/d) groups for the advancement of EN, IPF, SMF (EHF and AABF), and MF groups for the type of restart feeding. EEN infants had a lower incidence of intestinal stenosis and reoperation (43.5% vs. 77.6%, p = 0.002; 60.9% vs. 82.1%, p = 0.038), and a shorter duration of hospital stay after surgery and PN than LEN infants (14 days vs. 20 days, p < 0.001; 11 days vs. 17 days, p < 0,001). Faster advancing feed volumes contributes to a shorter duration of hospital stay and PN (15 days vs. 20 days, p < 0.001; 14 days vs. 17 days, p < 0,001), but a slow rate of weight gain (0.020 kg vs. 0.129 kg, p < 0.01). The rate of weight gain in the IPF group is quicker than SMF and MF (0.035 ml/kg/d vs. 0.016 ml/kg/d and 0.015 ml/kg/d, p = 0.042), and the time to repeat NPO in SMF group is shorter than IPF an MF groups (2.8 days vs. 4 days and 9.7 days, p < 0.01). Our study supports the beneficial effects of early enteral feeding and fast advancement of feed volumes of NEC and perforation term infants after surgery in reducing short-term complications and the duration of hospital stay after surgery and PN. Additionally, this study indicates that IPF and mixed feeding play a more important role in stimulating intestinal adoption recovery.