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Virtual elimination of necrotising enterocolitis for 5 years - reasons?
S Patole1, L McGlone, R Muller
1King Edward Memorial Hospital for Women, Western Australia 6008, Subiaco, Australia. skpatole@hotmail.com
Insights
A standardized feeding regimen for premature neonates significantly reduced time to full enteral feeds and nearly eliminated necrotizing enterocolitis (NEC) over five years. This simple strategy offers a promising approach to preventing NEC in vulnerable infants.
Area of Science:
- Neonatalogy
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Enteral feeding is crucial for neonates <32 weeks' gestation.
- Standardized feeding regimens aim to optimize nutrition and minimize complications.
- Previous trials explored prokinetics and laxatives in this population.
Purpose of the Study:
- To evaluate the impact of a standardized feeding regimen on enteral feeding progression and necrotizing enterocolitis (NEC) rates.
- To assess the long-term outcomes of a standardized feeding protocol implemented in clinical practice.
Main Methods:
- A standardized feeding regimen was implemented for neonates <32 weeks' gestation.
- Data collected over five years included feeding progression and NEC incidence.
- Comparison made with historical cohorts and outcomes from trials using erythromycin or carboxymethylcellulose.
Main Results:
- 298 neonates <32 weeks' gestation were included.
- Median age at starting feeds (AST) was 5 days; median days to reach full feeds (FFT) was 4 days.
- Only one case of definite NEC (≥Stage II) occurred; FFT was reduced by over 54% compared to historical data.
Conclusions:
- A standardized feeding regimen led to sustained reduction in time to full enteral feeds.
- The regimen was associated with a virtual elimination of ≥Stage II NEC over five years.
- Further controlled trials are needed to confirm the role of specific clinical policies in these outcomes.
Unlabelled:
A standardised feeding regimen was adopted in 1997 for guiding enteral feeding of neonates <32 weeks' gestation during clinical trials (18 months each) involving erythromycin (n=73) as a prokinetic and carboxymethylcellulose (n=70) as a laxative as well as for during 2 years (n=155) without any trials. Most aspects of the feeding regimen (e.g., milk increments-total volume/day, use of breast milk by choice, etc) were not significantly different from current practices.
Results:
298 neonates <32 weeks' gestation (<28 weeks; n=78) were enterally fed during the 5 years. Their demographic characteristics and median (interquartile) age in days at starting (AST) and days to reach full enteral feeds (FFT) of 150 ml/kg/day were not significantly different during these 5 years: [AST: 5 (3-7.5)], [FFT: 4 (3-7)] Only one case of definite NEC (> or =Stage II) occurred during the 5 years. The time to reach full feeds was also reduced by over 54% (including for neonates <28 weeks gestation) compared with a historical cohort.
Conclusion:
Sustained reduction in the time to reach full feeds with virtual elimination of > or =Stage II NEC for 5 years indicates continued benefits of a standardised feeding regimen as a simple preventive strategy to prevent NEC. Whether our specific policy of no enteral feeds in presence of hemodynamic instability associated with PDA requiring indomethacin, and/or sepsis played a role in achieving the significant results needs controlled trials.
