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Early enteral feeding does not affect the incidence of necrotizing enterocolitis
Insights
Early enteral nutrition for sick, very low birth weight infants on day 1 did not increase necrotizing enterocolitis. This approach safely provided higher energy and protein intake during the second week of life.
Area of Science:
- Neonatalogy
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Optimal timing for initiating enteral feedings in sick, very low birth weight (VLBW) infants remains a critical clinical question.
- Previous studies have raised concerns about potential risks associated with early enteral nutrition, including necrotizing enterocolitis (NEC).
Purpose of the Study:
- To investigate the safety and efficacy of initiating enteral feedings on day 1 versus day 7 of life in sick, VLBW infants.
- To compare the incidence of necrotizing enterocolitis and other clinical outcomes between early and late feeding groups.
Main Methods:
- A prospective study involving 34 sick, VLBW infants (<1500 g) randomly assigned to receive enteral feedings on day 1 (early group) or day 7 (late group).
- Both groups received parenteral nutrition with a standardized, progressive advancement of enteral feeds from sterile water to full-strength formula over seven days.
- Outcomes including NEC incidence, hospital course, and nutritional intake were compared between the two groups.
Main Results:
- Initiating enteral feedings on day 1 did not significantly increase the incidence, clustering, or earlier onset of necrotizing enterocolitis compared to the day 7 group.
- The overall NEC incidence was 29% in the early group and 35% in the late group, versus 4.2% in minimally sick VLBW neonates.
- Infants in the early feeding group achieved significantly higher energy and protein intake during their second week of life.
Conclusions:
- Providing dilute, early enteral calories to sick, VLBW infants on day 1 of life is safe and does not adversely affect the incidence of necrotizing enterocolitis.
- Early enteral feeding can lead to improved nutritional intake during the critical second week of life.
- These findings support the initiation of early enteral nutrition in select sick, VLBW neonates.
Abstract:
To begin to determine the optimal time for initiating enteral feedings, 34 sick, very low birth weight infants were prospectively selected from all neonates of less than 1,500 g (N = 116) and randomly divided into two groups. Infants were fed either on day 1 (early) or 7 (late) of life, according to a feeding protocol which included parenteral nutrition and a scheduled progression from sterile water to 2.5% dextrose, half-strength, and finally full-strength formula over seven days. The incidence of necrotizing enterocolitis and subsequent hospital course were compared. Initiating enteral feedings on day 1 did not significantly increase the incidence of necrotizing enterocolitis, produce a clustering of cases, or induce an earlier onset of necrotizing enterocolitis. The overall incidence of necrotizing enterocolitis in sick, very low birth weight neonates was 29% (5/17) and 35% (6/17) in the early and late groups, respectively, compared with 4.2% (2/47) in minimally sick, very low birth weight neonates. No significant differences between groups were seen in obstetrical complications, birth weight, gestational age, Apgar scores, presence of patent ductus arteriosus or intraventricular hemorrhage, use of umbilical catheterization, and respiratory or oxygen requirements. Infants fed enterally from day 1 did show a significantly higher energy and protein intake during the second week of life. These data show that providing dilute, early enteral calories does not adversely affect the incidence of necrotizing enterocolitis.