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The fear of necrotizing enterocolitis versus achieving optimal growth in preterm infants--an opinion
Orna Flidel-Rimon1, David Branski, Eric S Shinwell
1Department of Neonatology, Kaplan Medical Center, Rehovot, Israel.
Insights
Early enteral feeding for very-low-birthweight (VLBW) infants is crucial for growth. Concerns about necrotizing enterocolitis (NEC) should not impede timely nutritional support, as evidence supports early and rapid advancement of feeds.
Area of Science:
- Neonatology
- Pediatric Nutrition
- Infant Growth
Background:
- Very-low-birthweight (VLBW) infants experience significant growth delays.
- Current nutritional strategies often involve a combination of enteral and parenteral nutrition.
- Fear of necrotizing enterocolitis (NEC) leads to delayed enteral feeding in VLBW infants.
Purpose of the Study:
- To re-evaluate the nutritional strategies for VLBW infants.
- To challenge the traditional approach of delaying enteral feeds due to NEC concerns.
- To emphasize the importance of optimizing growth in VLBW infants.
Main Methods:
- Review of current evidence on enteral and parenteral nutrition in VLBW infants.
- Analysis of the impact of feeding strategies on infant growth.
- Assessment of the risks and benefits associated with early versus delayed enteral feeding.
Main Results:
- Early enteral feeding, advanced at rates of 20-35 ml/kg/d, demonstrates significant benefits for VLBW infants.
- Delayed enteral feeding, driven by NEC fears, contributes to marked growth delay.
- Optimizing enteral nutrition is key to improving growth outcomes.
Conclusions:
- The primary concern guiding nutritional strategies for VLBW infants should be inadequate growth, not the fear of NEC.
- Early and progressive enteral feeding should be prioritized.
- Revising current feeding protocols can enhance growth and development in VLBW infants.
Unlabelled:
Very-low-birthweight (VLBW) infants suffer marked growth delay despite well-intentioned efforts at combining enteral and parenteral nutrition. Fear of necrotizing enterocolitis (NEC) has traditionally influenced neonatologists toward delaying and progressing slowly with enteral feeding, while supporting the infant with parenteral nutrition. Current evidence suggests significant benefits of enteral feeding that is started early and advanced at rates of 20-35 ml/kg/d.
Conclusion:
We conclude that fear of inadequate growth should replace the fear of NEC in guiding nutritional strategies for these infants.
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