Comparison of fast- and slow-feeding rate schedules to the development of necrotizing enterocolitis

Book, Linda S.; Herbst, John J.; Jung, August L.

doi:10.1016/s0022-3476(76)80552-5

Cited by 94 publications

(47 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Four prior randomized trials found that more rapidly advancing feeding regimens in premature infants resulted in more rapid attainment of birth weight and shorter time to full feedings without increasing the incidence of NEC. [21][22][23][24] A case-control study found that infants who developed sepsis had feedings initiated later than infants who did not, but that infants who developed NEC were fed at the same age (3 to 4 days) as infants who did not. 25 In contrast, a randomized trial, comparing rapid vs slow advancement of feeding was discontinued early because of an increase in NEC in the rapid advancing group.…”

Section: Feeding Issuesmentioning

confidence: 99%

Clinical parameters do not adequately predict outcome in necrotizing enterocolitis: a multi-institutional study

et al. 2008

View full text Add to dashboard Cite

Objective: Necrotizing enterocolitis (NEC) remains a major cause of neonatal morbidity and mortality. Some infants recover uneventfully with medical therapy whereas others develop severe disease (that is, NEC requiring surgery or resulting in death). Repeated attempts to identify clinical parameters that would reliably identify infants with NEC most likely to progress to severe disease have been unsuccessful. We hypothesized that comprehensive prospective data collection at multiple centers would allow us to develop a model which would identify those babies at risk for progressive NEC.Study Design: This prospective, observational study was conducted at six university children's hospitals. Study subjects were neonates with suspected or confirmed NEC. Comprehensive maternal and newborn histories were collected at the time of enrollment, and newborn clinical data were collected prospectively, thereafter. Multivariate logistic regression analysis was used to develop a predictive model of risk factors for progression.Result: Of 455 neonates analyzed, 192 (42%) progressed to severe disease, and 263 (58%) advanced to full feedings without operation. The vast majority of the variables studied proved not to be associated with progression to severe disease. A total of 12 independent predictors for progression were identified, including only 3 not previously described: having a teenaged mother (odds ratio, OR, 3.14; 95% confidence interval, CI, 1.45 to 6.96), receiving cardiac compressions and/or resuscitative drugs at birth (OR, 2.51; 95% CI, 1.17 to 5.48), and having never received enteral feeding before diagnosis (OR, 2.41; 95% CI, 1.08 to 5.52). Conclusion:Our hypothesis proved false. Rigorous prospective data collection of a sufficient number of patients did not allow us to create a model sufficiently predictive of progressive NEC to be clinically useful. It appears increasingly likely that further analysis of clinical parameters alone will not lead to a significant improvement in our understanding of NEC. We believe that future studies must focus on advanced biologic parameters in conjunction with clinical findings.

show abstract

Section: Feeding Issuesmentioning

confidence: 99%

Clinical parameters do not adequately predict outcome in necrotizing enterocolitis: a multi-institutional study

et al. 2008

View full text Add to dashboard Cite

show abstract

“…En varios estudios se informa sobre esto (20,(23)(24)(25) y se señala que los incrementos de 20 ml/kg al día son seguros. En el presente estudio, se confirmó la seguridad de este incremento, en la medida en que la incidencia de enterocolitis en los dos grupos de pacientes fue similar, ambos dentro de valores razonables (26,27).…”

Section: Discussionunclassified

“…Esto incluye la práctica de no diluir la leche y el uso de un período muy corto de alimentación entérica hipocalórica de tan sólo dos días. La estandarización del proceso de atención de los niños prematuros en cuanto al método de alimentación, disminuye la incidencia de enterocolitis necrosante, tal como lo demostraron Tyson y Kennedy en un metanálisis de estudios observacionales (18,19). La explicación está relacionada con que la estandarización del proceso elimina de forma importante la yatrogenia, evitando que en algunos pacientes se inicien esquemas inconvenientes de alimentación.…”

Section: Discussionunclassified

See 1 more Smart Citation

Incidencia de enterocolitis necrosante en niños prematuros alimentados precozmente

et al. 2011

View full text Add to dashboard Cite

Introducción. La enterocolitis necrosante es una catástrofe multifactorial de los recién nacidos, generada por vasoconstricción visceral. Se discute el papel que juega el momento, tipo y velocidad de los incrementos de la vía oral en la patogenia de la entidad. Objetivo. Comparar la incidencia de enterocolitis necrosante y la mortalidad entre prematuros en quienes se inició alimentación entérica a las 48 horas de vida extrauterina, frente a otros en quienes se empezó al quinto día de vida. Materiales y métodos. Se llevó a cabo un ensayo clínico controlado de 239 neonatos de 750 a 1.500 gramos de peso y de 27 a 32 semanas de edad de gestación, asignados al azar, 135 a alimentación temprana y 104 a alimentación tardía con leche materna o fórmula láctea para prematuros. Se inició con un mililitro cada seis horas, para progresar en intervalos de tres horas y un incremento diario de hasta 20 ml/kg hasta llegar a 150 ml/kg al día, siempre y cuando no se observaran signos o síntomas de intolerancia a la vía oral. Resultados. Se presentaron 14 casos de enterocolitis necrosante en el grupo de alimentación temprana (10,4 %) y nueve (8,7 %) en el de alimentación tardía (RR=1,22; IC 95 % 0,49-3,20; p=0,652). Cinco (3,7 %) niños fallecieron en el grupo de alimentación temprana (IC 95 % 1,4-8,9) y ocho (7,7 %), en el de alimentación tardía (IC 95 % 3,6-15,0), sin que estas diferencias fueran significativas (RR=0,46; IC 95 % 0,12-1,60; p=0,182). Conclusión. El iniciar en forma temprana la alimentación entérica en neonatos prematuros no aumenta el riesgo de enterocolitis necrosante ni el de mortalidad y sí representa grandes ventajas para estos pacientes.Palabras clave: enterocolitis necrosante, alimentación entérica, leche humana, recién nacido. Necrotizing enterocolitis among preterm newborns with early feedingIntroduction. The development of necrotizing enterocolitis is a common and serious risk to newborns. It is caused by splanchnic bed vasoconstriction that can produce intestinal necrosis. The role of onset time, type and, speed enhancements of The factors of enteral feeding related with necrotizing enterocolitis genesis such as feeding onset, type and frequency are not well understood. Objective. The incidence of necrotizing enterocolitis and mortality among infants will be compared in infants whose enteral feeding was initiated 48 hours after birth to those whose feeding began on day 5 postpartum. Materials and methods. A controlled clinical trial was conducted among 239 newborns weighing between 750-1,500 g and a gestation age of 27-32 weeks of gestational age. The infants were randomly assigned to two groups--135 to an early feeding regime and 104 to delayed feeding. Breast milk or formula milk was used. Feeding was begun with one ml every six hours, progressing to three hour intervals and 20 ml/kg daily. This was increased to 150 ml/kg-d if the infant condition remained stable and it manifested no oral intolerance. Contribuciones de los autores:Luis Alfonso Pérez: diseño, captación de pacientes, análisis y elaboració...

show abstract

“…19 This feeding advancement guideline was based on previous evidence demonstrating that prolonged small feeding volumes in preterm infants decreases the incidence of NEC. 20,21 …”

Section: Early Human Milk Feedingsmentioning

confidence: 99%

Quality Improvement Initiative to Reduce the Necrotizing Enterocolitis Rate in Premature Infants

Talavera

Bixler²,

Cozzi³

et al. 2016

Pediatrics

View full text Add to dashboard Cite

OBJECTIVE: To reduce the incidence of necrotizing enterocolitis (NEC) among very low birth weight (VLBW) infants admitted to 8 intensive care nurseries from a 2010 baseline of 8.0% to <4.0% by 2012 and sustain for 6 months using quality improvement (QI) methodology. METHODS: A multidisciplinary NEC QI team used the Vermont Oxford Network definition of NEC and the Institute for Healthcare Improvement model. The specific aims were evidenced based and included (1) standardized early human milk feedings, (2) conservative feeding guidelines during blood transfusions and indomethacin treatment, and (3) restriction of ranitidine use in VLBW infants. Inclusion criteria included VLBW infants admitted within the study period without NEC. Exclusion criteria included established NEC or spontaneous intestinal perforation unrelated to NEC. The incidence of NEC and NEC-related surgery were tracked using statistical process control methodology. RESULTS: The baseline NEC rate in 2010 was 8% (27 NEC cases in 335 VLBW infants). After initiation of early human-milk feeding and conservative feeds during blood transfusions guidelines in November 2011, only 3.1% (19 of 606 VLBW infants) had developed NEC through December 2013 (P = .001). Special cause variation was noted in June 2012 establishing a new centerline at 3.1%. NEC-related mortality decreased from a 2010 baseline mean of 2.7% to a new baseline mean of 0.9% from January 2011 to December 2013. CONCLUSIONS: Implementation of QI initiatives decreased the NEC rate from 8.0% to <4.0%. Early human milk feedings and conservative feeding during blood transfusion policies appear to have significant impact on NEC reduction.

show abstract

Comparison of fast- and slow-feeding rate schedules to the development of necrotizing enterocolitis

Cited by 94 publications

References 8 publications

Clinical parameters do not adequately predict outcome in necrotizing enterocolitis: a multi-institutional study

Clinical parameters do not adequately predict outcome in necrotizing enterocolitis: a multi-institutional study

Incidencia de enterocolitis necrosante en niños prematuros alimentados precozmente

Quality Improvement Initiative to Reduce the Necrotizing Enterocolitis Rate in Premature Infants

Contact Info

Product

Resources

About