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Nutritional management after necrotizing enterocolitis and focal intestinal perforation in preterm infants
Ingrid Mo1, Alexandre Lapillonne2,3, C H P van den Akker4,5
1Department of Clinical Research, University of Southern Denmark, 5000, Odense, Denmark.
Insights
Nutritional management for preterm infants after necrotizing enterocolitis (NEC) or focal intestinal perforation (FIP) lacks high-quality evidence. A multidisciplinary consensus guideline is recommended, prioritizing mother's own milk when restarting enteral nutrition.
Area of Science:
- Neonatology
- Pediatric Surgery
- Clinical Nutrition
Background:
- Nutritional management for preterm infants recovering from necrotizing enterocolitis (NEC) or focal intestinal perforation (FIP) is complex, particularly for surgically managed cases.
- Current feeding practices rely on physiological principles and unit consensus rather than robust evidence, leading to variability in care.
- There is a lack of established nutritional standards across neonatal units for infants post-NEC or FIP.
Purpose of the Study:
- To review existing literature on nutritional management strategies for preterm infants following NEC or FIP.
- To summarize evidence regarding the timing of enteral nutrition reinitiation, optimal feeding types, and advancement protocols.
- To discuss critical aspects like micronutrient deficiencies, cholestasis, stoma output management, and stoma closure timing.
Main Methods:
- A narrative review of the scientific literature.
- Synthesis of information on nutritional interventions, including timing, type, and advancement of feeds.
- Discussion of associated complications and surgical considerations.
Main Results:
- High-quality evidence to support evidence-based recommendations for nutritional practices post-NEC or FIP is insufficient.
- Mother's own milk is suggested as the preferred option for restarting enteral nutrition.
- Significant need for further research and development of standardized guidelines.
Conclusions:
- There is a critical lack of high-quality studies to guide nutritional management after NEC or FIP in preterm infants.
- A consensus-based early nutrition guideline developed by a multidisciplinary team is recommended.
- Urgent need for nutritional research in this vulnerable patient population to establish evidence-based practices.
Abstract:
Nutritional management of preterm infants recovering from necrotizing enterocolitis (NEC) or focal intestinal perforation (FIP) is challenging, especially in infants managed surgically. The logistics of how, when, and what to feed are unclear and current nutritional practices are primarily based on physiological principles and consensus opinion in individual units, rather than high-quality evidence. The aim of this narrative review is to summarize the literature on nutritional management after NEC or FIP in preterm infants: when to restart enteral nutrition, type of enteral nutrition to use, and how to advance nutrition. We also discuss treatment of micronutrient deficiencies, cholestasis, replacement of stoma losses, and optimal time of stoma closure. In conclusion, there are in sufficient high-quality studies available to provide evidence-based recommendations on the best nutritional practice after NEC or FIP in preterm infants. A local or national consensus based early nutrition guideline agreed upon by a multidisciplinary team including pediatric surgeons, pediatricians/neonatologists, nurses, and nutritionists is recommended. Further studies are urgently needed. IMPACT: There is no good quality evidence or nutritional standard across neonatal units treating infants after medical or surgical NEC or FIP. With this review we hope to start providing some consistency across patients and between providers treating patients with NEC and FIP. Mother's own milk is recommended when restarting enteral nutrition after NEC or FIP. In the absence of high-quality evidence, a consensus based early nutrition guideline agreed upon by a multidisciplinary team is recommended. Nutritional research projects are urgently needed in NEC and FIP patients.
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