Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants

Morgan, Jessie; Young, Lauren; McGuire, William

doi:10.1002/14651858.cd001970.pub4

Cited by 29 publications

(32 citation statements)

References 52 publications

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“…Although no benefit has been shown for delayed (12) or slow (13) introduction of EF in the prevention of NEC, evidence is lacking on the length of the period between the treatment of NEC and the moment at which EF can be restarted safely. Although a period of 7-10 d of discontinuation of EF has been recommended (14), faster reintroduction after NEC seems feasible in some cases.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive measurement of intestinal epithelial damage at time of refeeding can predict clinical outcome after necrotizing enterocolitis

et al. 2012

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Section: Discussionmentioning

confidence: 99%

Noninvasive measurement of intestinal epithelial damage at time of refeeding can predict clinical outcome after necrotizing enterocolitis

et al. 2012

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“…Sisk et al 29 have reported a significant decrease in the risk of NEC with early breast milk feeding in preterm infants, while a recent Cochrane systematic review concluded that delaying the introduction of enteral feeds for up to 5-7 days did not increase the risk of developing NEC in very preterm infants. 30 (Table 2). 31 A more recent classification was proposed by Gordon et al, 32 encompassing other acquired neonatal gastrointestinal disorders in the preterm infant that might mimic NEC, such as feeding intolerance of prematurity, viral enteritis of infancy, spontaneous intestinal perforation, NEC caused predominantly by ischemia, and cow's milk protein allergy.…”

Section: Bacterial Colonizationmentioning

confidence: 99%

“…Once trophic feeds have been started, the timing of increasing enteral feeds is still unclear. A Cochrane systematic review compared the commencement of increasing enteral feeds (either within 4 days or later than 5-7 days), 30 and found no differences in the incidence of NEC (relative risk [RR] 0.92, 95% CI 0.64-1.34) or all-cause mortality (RR 1.26, 95% CI 0.78-2.01) between these two groups. An additional concern is the rate of increase of enteral feeds in the most vulnerable preterm infants.…”

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confidence: 99%

Necrotizing enterocolitis: current perspectives

Yajamanyam

Rasiah²,

Ewer³

2014

RRN

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Necrotizing enterocolitis is the most common gastrointestinal emergency in neonates, particularly in those born very preterm. It is a leading cause of morbidity and mortality, especially in extremely low birth weight infants. Despite extensive research, the pathophysiology of necrotizing enterocolitis remains unclear and therapeutic options are limited. Multiple risk factors have been reported, but most are associated with prematurity and its complications. This makes management very challenging in vulnerable preterm infants. In this review, we focus on the risk factors and some of the current research in this area, particularly studies aimed at early detection and potential preventive measures for this potentially lethal condition.

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“…Early GI maturation may help to prevent later adverse effects of slow growth and inadequate nutrient intake in preterm infants (30). On the other hand, too rapid advancement of enteral feeding is associated with high NEC risk, and delayed advancement of enteral feeding may decrease NEC risk in both preterm infants and pigs (20,32,33). Consequently, a gradual introduction of mother's own milk, donor milk, or infant formula ("minimal enteral nutrition," daily increases of 10 -20 ml·kg Ϫ1 ·day Ϫ1 ), is often used for 1-2 wk after birth as adjunct to parenteral nutrition (PN), before transition to full enteral feeding at 2-4 wk (e.g., 150 -180 ml·kg Ϫ1 ·day Ϫ1 ).…”

mentioning

confidence: 99%

Rapid gut growth but persistent delay in digestive function in the postnatal period of preterm pigs

Hansen

Thymann

Andersen

et al. 2016

American Journal of Physiology-Gastrointestinal and Liver Physi

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Preterm infants often tolerate full enteral nutrition a few weeks after birth but it is not known how this is related to gut maturation. Using pigs as models, we hypothesized that intestinal structure and digestive function are similar in preterm and term individuals at 3-4 wk after birth and that early enteral nutrition promotes maturation. Preterm or term cesareandelivered pigs were fed total parenteral nutrition, or partial enteral nutrition [Enteral (Ent), 16 -64 ml·kg Ϫ1 ·day Ϫ1 of bovine colostrum] for 5 days, followed by full enteral milk feeding until day 26. The intestine was collected for histological and biochemical analyses at days 0, 5, and 26 (n ϭ 8 -12 in each of 10 treatment groups). Intestinal weight (relative to body weight) was reduced in preterm pigs at 0 -5 days but ENT feeding stimulated the mucosal volume and peptidase activities. Relative to term pigs, mucosal volume remained reduced in preterm pigs until 26 days although plasma glucagon-like peptide 2 (GLP-2) and glucose-dependent insulin-trophic peptide (GIP) levels were increased. Preterm pigs also showed reduced hexose absorptive capacity and brush-border enzyme (sucrase, maltase) activities at 26 days, relative to term pigs. Intestinal structure shows a remarkable growth adaptation in the first week after preterm birth, especially with enteral nutrition, whereas some digestive functions remain immature until at least 3-4 wk. It is important to identify feeding regimens that stimulate intestinal maturation in the postnatal period of preterm infants because some intestinal functions may show long-term developmental delay. prematurity; gut development; enzymes; digestion; glucagon-like peptide 2 ABOUT 10% OF ALL INFANTS are born preterm (Ͻ37 weeks of gestation) and the proportion is increasing in most countries (6). Preterm infants show an increased susceptibility to infections, respiratory distress syndrome, intracranial hemorrhage, bronchopulmonary dysplasia, retinopathy of prematurity, extrauterine growth restriction, neurodevelopmental disturbances, and necrotizing enterocolitis (NEC) (21, 31). The challenges are inversely related to gestational age at birth and the most severe adaptation problems occur during the first few weeks after birth. If preterm infants survive the difficult neonatal period, their body functions often adapt well, although some organ systems may show long-term developmental delay or deficits (18). It remains unknown how different organ systems adapt in preterm infants and when parameters of structure and function become similar to those in term infants. For gastrointestinal (GI) functions, eating disorders and dysregulated appetite have been reported in preterm infants (44) but very little is known about the long-term adaptation of the GI tract in preterm neonates.Investigations of postnatal GI adaptation in preterm neonates are difficult without an animal model that combines preterm birth, high NEC risk, and clinically relevant feeding interventions, such as parenteral and enteral nutrition. Piglets delivere...

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Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants

Abstract: Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants (Review)

Cited by 29 publications

References 52 publications

Noninvasive measurement of intestinal epithelial damage at time of refeeding can predict clinical outcome after necrotizing enterocolitis

Noninvasive measurement of intestinal epithelial damage at time of refeeding can predict clinical outcome after necrotizing enterocolitis

Necrotizing enterocolitis: current perspectives

Rapid gut growth but persistent delay in digestive function in the postnatal period of preterm pigs

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