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Standardized Slow Enteral Feeding Protocol and the Incidence of Necrotizing Enterocolitis in Extremely Low Birth
Sreekanth Viswanathan1, Kera McNelis2, Dennis Super3
1Division of Neonatology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio sreekanth.viswanathan@uhhospitals.org.
Insights
A standardized slow enteral feeding protocol reduced necrotizing enterocolitis (NEC) in very low birth weight infants. Surviving infants achieved similar discharge weights without longer hospital stays.
Area of Science:
- Neonatalogy
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Necrotizing enterocolitis (NEC) is a significant concern in extremely low birth weight (ELBW) infants.
- Optimal timing for enteral feeding initiation and advancement in ELBW infants remains under investigation.
- Delayed enteral feeding strategies require further study to assess their impact on NEC incidence.
Purpose of the Study:
- To evaluate the clinical outcomes of a standardized slow enteral feeding (SSEF) protocol in ELBW infants.
- To compare the incidence of NEC and other short-term outcomes between infants on an SSEF protocol and historical controls.
- To assess the impact of SSEF on growth and hospital stay duration in surviving ELBW infants.
Main Methods:
- A retrospective cohort study comparing ELBW infants on an SSEF protocol (2009-2012) with historical controls (2003-2009).
- Propensity score (PS) analysis was used to compare short-term outcomes between the two groups.
- Key outcomes included feeding initiation, time to full enteral feeding, parenteral nutrition duration, and NEC incidence.
Main Results:
- Infants on the SSEF protocol experienced longer times to feeding initiation and full enteral feeding, as well as increased parenteral nutrition and central line days.
- No significant difference in overall or surgical NEC was observed between the SSEF and control groups.
- However, in infants with birth weight <750g, the SSEF protocol significantly reduced NEC incidence and combined NEC/death rates.
Conclusions:
- A standardized slow enteral feeding protocol significantly decreases NEC and combined NEC/death in the most vulnerable ELBW infants (<750g).
- Despite a slower advancement to full enteral feeds, surviving ELBW infants on this protocol achieved comparable discharge weights.
- The SSEF protocol did not prolong the hospital stay for surviving ELBW infants.
Background:
Compared with early enteral feeds, the delayed introduction and slow advancement of enteral feedings to reduce the incidence of necrotizing enterocolitis (NEC) are not well studied in extremely low birth weight (ELBW) infants.
Objective:
To study the effects of a standardized slow enteral feeding (SSEF) protocol in ELBW infants.
Methods:
ELBW infants who followed an SSEF protocol (September 2009 to December 2012) were compared with a similar group of historical controls (January 2003 to July 2009). Short-term outcomes between the 2 groups were compared by propensity score (PS) analysis.
Results:
One hundred twenty-five infants in the SSEF group were compared with 294 historical controls. Compared with the controls, feeding initiation day, full enteral feeding day, parenteral nutrition (PN) days, and total central line days were longer in the SSEF group. There was no significant difference in overall NEC (5.6% vs 11.2%, respectively; P = .10) or surgical NEC (1.6% vs 4.8%, respectively; P = .17) between the SSEF group and controls. However, in infants with birth weight <750 g, NEC (2.1% vs 16.2%, respectively; P < .01) or combined NEC/death (12.8% vs 29.5%, respectively; P = .03) was significantly less in the SSEF group compared with controls. In infants who survived to discharge, there was no significant difference in the discharge weight or length of stay in PS-adjusted analysis.
Conclusions:
An SSEF protocol significantly reduces the incidence of NEC and combined NEC/death in infants with birth weight <750 g. Despite taking longer to achieve full enteral feeding on this protocol, surviving ELBW infants demonstrated comparable weight gain at discharge without prolonging their hospital stay.
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