Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants

Oddie, Sam; Young, Lauren; McGuire, William

doi:10.1002/14651858.cd001241.pub7

Cited by 148 publications

(140 citation statements)

References 51 publications

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“…For stable infants, a small amount (0.5–1 mL/kg/h) of breast milk can be started early to initiate enteral feeding [166]. There is no evidence of increased NEC with advancing feeds fairly rapidly up to 30 mL/kg/day in stable VLBW babies [167]. Mother’s milk is the preferred option for initiation of feeding; however, if not available then pasteurised donor breast milk is better than formula for reducing risk of NEC but will result in slower postnatal growth [168].…”

Section: Monitoring and Supportive Carementioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of “European Guidelines for the Management of RDS” by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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Section: Monitoring and Supportive Carementioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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“…Systematic reviews and meta-analyses of data from these trials do not provide evidence that delayed introduction or slow advancement of feed volumes reduce the risk of NEC or mortality in very preterm infants, but they do raise concerns that conservative enteral feeding strategies in the early neonatal period prolong exposure to parenteral nutrition and might be associated with an increased risk of late-onset infection (Fig. 2, 3) [45, 46]. …”

Section: Early Enteral Feeding Strategiesmentioning

confidence: 99%

“… Summary meta-analysis of slower (≤24 mL/kg/day) versus faster rates of advancement of enteral feed volumes [46]. NEC, necrotising enterocolitis.…”

Section: Early Enteral Feeding Strategiesmentioning

confidence: 99%

Immunonutrition for Preterm Infants

Walsh

McGuire²

2019

Neonatology

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Care and outcomes for very preterm infants continue to improve, but important causes of mortality and acute and long-term morbidity associated with prolonged hospitalisation remain. Necrotising enterocolitis (NEC) and late-onset infection have emerged as the major causes of death beyond the early neonatal period and of neurodisability in very preterm infants. Although the pathogenesis of these conditions is incompletely understood, it appears to be related to the content and mode of delivery of the enteral diet, particularly the impact of immunonutrients from human breast milk on the microbial and metabolic balance within the immature intestine. Evidence exists to support investment in measures to help mothers to express breast milk as the primary source of nutrition for their very preterm infants. In the absence of maternal milk, pasteurised donor breast milk provides protection against NEC, but its nutritive adequacy is not clear and its cost-effectiveness is uncertain. Supplementation with individual immunonutrients, including immunoglobulins and lactoferrin, has not been shown to be effective in preventing NEC or infection in randomised controlled trials. The evidence base for prebiotics and probiotics is stronger, but concerns exist about the choice, safety and availability of formulations. Other strategies – including avoidance of drugs such as gastric acid suppressants that compromise innate immunity, as well as evidence-based progressive feeding strategies that reduce exposure to invasive interventions – are emerging as key components of care packages to reduce the burden of NEC, infection and associated growth and developmental faltering for very preterm infants.

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“…Many respondents answered that they start to increase the volume of EN by 10–20 mL/kg/day per day. A study comparing a group with a higher daily increase rate of EN (15–20 mL/kg/day) with a group with a lower rate of increase (30–40 mL/kg/day) did not show any significant difference in the onset of NEC between these groups and suggested that a faster increase is more beneficial as full feeding is achieved earlier . The number of days taken to establish EN tended to be greater for infants with lower birthweight.…”

Section: Discussionmentioning

confidence: 99%

Survey of a nutrition management method for very low birthweight infants: Status before wide use of breast milk banks in Japan

Oikawa

Sakurai

Murakawa

et al. 2020

Pediatrics International

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Background The importance of breast‐feeding for very low birthweight (VLBW) infants has been pointed out. Some overseas studies suggested that the standardization of enteral nutrition (EN) leads to improved prognosis in VLBW infants. In Japan, however, physicians in charge of infants are responsible for making nutrition management decisions on an individual basis. We conducted an online survey to clarify the course of nutrition management of VLBW infants currently implemented in Japan. Methods We mailed a notice to 300 representative neonatologists throughout Japan requesting their participation in the online survey. On the survey website, neonatologists responded to questions regarding the nutritional strategy for five birthweight groups (less than 500 g, 500–749 g, 750–999 g, 1,000–1,249 g and 1,250–1,499 g). Results Responses were recieved from 137 neonatologists. The first choice for EN up to 1 week after birth was breast milk regardless of birthweight (92.0% for 1,250–1,499 g to 95.6% for 500–999 g). More than 30% of the respondents answered that they fast infants who weigh <750 g at birth or feed them with other mothers’ breast milk until their own mother’s milk becomes available. The lower the birthweight, the later EN is started, and the greater the number of days to establish EN. Conclusion The lower the birthweight, the more difficult it is to feed infants their own mother’s milk and the later the EN is started. If donor milk is supplied in a stable manner, it takes fewer days to establish EN.

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Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants

Abstract: Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants (Review)

Cited by 148 publications

References 51 publications

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

Immunonutrition for Preterm Infants

Survey of a nutrition management method for very low birthweight infants: Status before wide use of breast milk banks in Japan

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