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Published on: January 27, 2019
Time to Full Enteral Feeds and Late-Onset Sepsis in Extremely Preterm Infants
Ariel A Salas1, Laura Elizabeth Wiener2, Marissa Trotta2
1Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham.
Insights
Achieving full enteral feeding sooner in preterm infants significantly lowers the risk of late-onset sepsis and growth issues. Early nutrition support is key for better outcomes in vulnerable newborns.
Area of Science:
- Neonatalogy
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Early achievement of full enteral feeding is linked to improved clinical outcomes in preterm infants.
- Late-onset sepsis (LOS) is a significant concern in preterm neonates, impacting morbidity and mortality.
- Understanding the relationship between enteral feeding advancement and LOS is crucial for optimizing neonatal care.
Purpose of the Study:
- To investigate the association between the timing of achieving full enteral feeding and the incidence of late-onset sepsis in preterm infants.
- To evaluate the impact of delayed enteral feeding on other critical neonatal outcomes, including necrotizing enterocolitis and growth faltering.
Main Methods:
- Secondary analysis of a multicenter prospective cohort study involving preterm infants (23-28 weeks gestational age).
- Included infants without major anomalies who received enteral feedings and survived beyond postnatal day 7.
- Assessed the primary outcome of culture-positive late-onset sepsis and secondary outcomes like necrotizing enterocolitis and growth faltering, adjusting for clinical variables.
Main Results:
- A decrease in the median time to achieve full enteral feeding was observed from 18 to 14 days between 2012 and 2021.
- The incidence of late-onset sepsis decreased concurrently from 21.1% to 16.5%.
- Each additional week of delay in achieving full enteral feeding was associated with a 16% increased risk of LOS, and higher risks of necrotizing enterocolitis and growth faltering.
Conclusions:
- Delays in establishing full enteral feeding in preterm infants (23-28 weeks gestational age) are significantly associated with an increased risk of late-onset sepsis.
- Early initiation and advancement of enteral nutrition appear to be protective factors against LOS, necrotizing enterocolitis, and growth faltering.
- Optimizing enteral feeding strategies may improve clinical outcomes and reduce the incidence of serious complications in preterm neonates.
Importance:
Recent studies suggest that early achievement of full enteral feeding improves clinical outcomes among preterm infants.
Objective:
To examine the association between full enteral feeding and late-onset sepsis.
Design, Setting, And Participants:
This secondary analysis of a cohort study prospectively followed up a multicenter cohort of preterm infants with gestational ages ranging from 23 to 28 weeks born between January 1, 2012, and December 31, 2021, at 19 US academic centers. Infants without major anomalies who received enteral feedings and survived beyond postnatal day 7 were included.
Exposure:
Full enteral feeding (≥120 mL/kg/d).
Main Outcomes And Measures:
The primary outcome was the incidence of late-onset sepsis confirmed through culture-positive results occurring more than 72 hours after birth and treated with antibiotics for 5 or more days. Other clinical outcomes assessed up to 36 weeks of postmenstrual age included necrotizing enterocolitis, death, and growth faltering (weight, length, or head circumference z score decrease >1.2). Risk estimates were adjusted for clinical variables associated with acute critical illness and birth year.
Results:
Demographic and clinical data from 15 102 preterm infants were analyzed (mean [SD] maternal age, 28.7 [6.1] years; mean [SD] gestational age, 26.0 [1.6] weeks; mean [SD] birth weight, 875 [242] g; 7648 male [50.6%]). Between January 1, 2012, and December 31, 2021, the median (IQR) time to achieve full enteral feeding decreased from 18 (14-28) days to 14 (10-22) days, and the incidence of late-onset sepsis decreased from 21.1% to 16.5% (P = .003). In adjusted analyses, the relative risk of late-onset sepsis per each additional 1-week delay in achieving full enteral feeding was 16% higher (adjusted relative risk [ARR], 1.16; 95% CI, 1.14-1.18; P < .001). Delays in achieving full enteral feeding were also associated with a higher risk of necrotizing enterocolitis (ARR, 1.20; 95% CI, 1.16-1.24; P < .001) and growth faltering in weight (ARR, 1.08; 95% CI, 1.07-1.09), length (ARR, 1.03; 95% CI, 1.02-1.03), and head circumference (ARR, 1.07; 95% CI, 1.06-1.08; P < .001 for all).
Conclusions And Relevance:
In this cohort study of preterm infants with gestational ages ranging from 23 to 28 weeks who received enteral feeds and survived beyond postnatal day 7, delays in establishing full enteral feeding were associated with a higher risk of late-onset sepsis. These results suggest that early initiation and advancement of enteral feeding have the potential to reduce the risk of late-onset sepsis, growth faltering, and necrotizing enterocolitis.
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