Reduction in necrotising enterocolitis after implementing an evidence-based enteral nutrition protocol in very low birth weight newborns

Sánchez-Tamayo, Tomás; Fernández, María Gracia Espinosa; Affumicato, Laura; López, María González; Romero, Verónica Fernández; Algarra, María; García, Enrique Salguero

doi:10.1016/j.anpede.2016.10.004

Cited by 4 publications

(3 citation statements)

References 25 publications

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“…Although we found no statistically significant differences between neonates that developed NEC vs. control infants in gestational age or IUGR in our study, it has been reported that more than 85% of NEC cases are less than 32 weeks’ gestation [ 18 , 19 ]. We also found that NEC cases in this study have a mean of 30 weeks and this is also in accordance with a study of Sharma and cols.…”

Section: Discussioncontrasting

confidence: 90%

Estimating Neonatal Necrotizing Enterocolitis Based on Feeding Practices

et al. 2021

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(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.

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Section: Discussioncontrasting

confidence: 90%

Estimating Neonatal Necrotizing Enterocolitis Based on Feeding Practices

et al. 2021

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“…The optimal feeding strategy for the most immature infants remains unclear and lacks consensus. Standardized feeding regimens have been, however, associated with reduction of NEC risk (23,24). A recent systematic review of observational studies found an 80% reduction in relative risk of NEC with the use of standardized feeding protocols compared with nonstandardized regimens (RR: 0.22; 95% CI ¼ 0.13-0.36; 15 studies, 18,160 infants) (23).…”

Section: Discussionmentioning

confidence: 99%

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

Masoli

Domínguez

Tapia³

et al. 2021

Journal of Pediatric Gastroenterology &Amp; Nutrition

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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.

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“…As shown in our results, the mean age when enteral feeding was initiated was 3 days (Table 2). Early initiation of enteral feeding has been proven to decrease mortality and the rate of NEC [8, 9]. We adopted a tapered increase protocol of 20 mL/kg/day.…”

Section: Discussionmentioning

confidence: 99%

Nutritional Support of Very Low Birth Weight Infants in a Tertiary Center in a Developing Country

et al. 2019

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BackgroundVery low birth weight infants (VLBWIs) are at high risk for nutritional deficiency. Enteral feeding is usually challenged by increased risk of necrotizing enterocolitis (NEC). The nutritional needs of VLBWIs are usually dependent on parenteral nutrition during early postnatal life. This study aimed to evaluate the nutritional service of VLBWIs at Jordan University Hospital.MethodsThis was a prospective follow-up study of VLBWIs with birth weight ≤ 1,500 g. Data were extracted from medical charts and laboratory database.ResultsIn total, 43 VLBWIs met our inclusion criteria; of them, 21% were extremely low birth weight infants (ELBWIs). The mean gestational age was 29 weeks, and the mean birth weight was 1,218 g. The mean age of starting feeds was 3 days. Mean full feed age is 2 weeks. The most common side effect of total parenteral nutrition (TPN) was hypertriglyceridemia (35%).ConclusionsNutritional care of VLBWIs is well established in our center. Initiating fortification earlier and working to increase mother’s own breast milk supply is vital to improve growth in low resource setting.

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Reduction in necrotising enterocolitis after implementing an evidence-based enteral nutrition protocol in very low birth weight newborns

Cited by 4 publications

References 25 publications

Estimating Neonatal Necrotizing Enterocolitis Based on Feeding Practices

Estimating Neonatal Necrotizing Enterocolitis Based on Feeding Practices

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

Nutritional Support of Very Low Birth Weight Infants in a Tertiary Center in a Developing Country

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