Standardized slow enteral feeding protocol reduces necrotizing enterocolitis in micropremies

Area of Science:

• Neonatalogy
• Pediatric Gastroenterology
• Critical Care Medicine

Background:

• Necrotizing enterocolitis (NEC) is a significant concern in micropreemies (<750g birth weight).
• Optimal enteral feeding strategies to prevent NEC in this vulnerable population are not well-established.
• Delayed introduction and slow advancement of enteral feeds are potential strategies requiring further study.

Purpose of the Study:

• To evaluate the impact of a standardized slow enteral feeding (SSEF) protocol on NEC incidence in micropreemies.
• To compare outcomes of SSEF with historical controls receiving earlier and faster enteral feeding advancement.
• To assess the safety and efficacy of delayed and slow enteral feeding in extremely low birth weight infants.

Main Methods:

• A pre-post case control study design was employed.
• Micropreemies were divided into two groups: SSEF (n=92) and historical controls (PreSSEF, n=129).
• The SSEF protocol involved withholding enteral feeds for 10-14 days and advancing at <10 ml/kg/day.

Main Results:

• The SSEF group showed a significant reduction in NEC (1.1% vs. 16.2%), surgical NEC (0.0% vs. 7.8%), and NEC/death (7.6% vs. 29.5%) compared to PreSSEF.
• While feeding initiation and full enteral feeding days were longer in SSEF, breast milk initiation was higher.
• The SSEF group experienced more cholestasis but similar rates of late-onset sepsis; survivors had better growth parameters at discharge.

Conclusions:

• A standardized slow enteral feeding (SSEF) protocol is effective in significantly reducing NEC incidence and NEC-related mortality in micropreemies.
• The SSEF protocol demonstrates improved growth outcomes in surviving infants.
• Delayed enteral feeding initiation and slow advancement represent a safe and beneficial strategy for managing micropreemies at risk for NEC.