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

Young, Lauren; Oddie, Sam; McGuire, William

doi:10.1002/14651858.cd001970.pub6

Cited by 24 publications

(26 citation statements)

References 83 publications

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“…Preterm infants diagnosed with NEC often have a variety of long-term complications, which have caused a huge economic burden to the family and society. Therefore, the prevention of NEC is more important than the treatment of NEC ( 15 ). Current studies mostly believe that OAC may prevent NEC through the following aspects: (1) enhance the interaction between cytokines in colostrum and oropharyngeal mucosal tissues to provide systemic protective immunostimulatory effects; (2) protective biokines exert their antibacterial, anti-inflammatory, immunomodulatory, and antioxidant effects; (3) establish mucosal barrier protection against pathogens; (4) oligosaccharides prevent pathogen colonization, proliferation, and translocation not only by promoting symbiotic bacterial colonization but also by direct interaction with epithelial cells to maintain intestinal integrity; (5) anti-inflammatory effects; and (6) antioxidant effects ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

Intervention Effect of Oropharyngeal Administration of Colostrum in Preterm Infants: A Meta-Analysis

et al. 2022

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ObjectiveTo evaluate the efficacy and safety of oropharyngeal administration of colostrum (OAC) in preterm infants.MethodsWe searched Embase, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the website of the clinical trials, search time was from the establishment of the databases or websites up to 1 February 2022. Preterm infants with gestational age (GA) ≤ 32 weeks or birth weight (BW) ≤ 1500 g were taken as the participants, collect randomized controlled trials (RCTs) of comparing OAC and placebo or no intervention in preterm infants. Two researchers independently screened the literature, extracted the data, and evaluated the quality of the literature, and we adopted Review Manager 5.3 software for meta-analysis.ResultsIn total, 11 RCTs (n = 1,173) were included in the review. A meta-analysis showed significant difference in the incidence of necrotizing enterocolitis [NEC; p = 0.009, relative ratio (RR) = 0.51, 95% confidence interval (CI) = 0.31–0.84], late-onset sepsis (LOS; p = 0.02, RR = 0.75, 95% CI = 0.59–0.95), ventilator-associated pneumonia (VAP; p = 0.03, RR = 0.48, 95% CI = 0.24–0.95), the time to reach full enteral feeds (p < 0.00001, mean difference (MD) = −3.40, 95% CI = −3.87 to −2.92), duration of hospital stay (p < 0.00001, MD = −10.00, 95% CI = −11.36 to −8.64), and the rate of weight gain (kg.d; p < 0.00001, MD = 2.63, 95% CI = 2.10–3.16) between the colostrum group and control group. Meanwhile, researchers found no significant difference between the colostrum group and control group in the incidence of bronchopulmonary dysplasia (BPD; p = 0.17, RR = 0.83, 95% CI = 0.64–1.08), intraventricular hemorrhage (IVH; grade ≥3; p = 0.05, RR = 0.44, 95% CI = 0.19–1.01), periventricular leukomalacia (PVL; p = 0.67, RR = 0.70, 95% CI = 0.14–3.49), retinopathy of prematurity (ROP; p = 0.29, RR = 1.25, 95% CI = 0.82–1.89), and patent ductus arteriosus (PDA; p = 0.17, RR = 1.22, 95% CI = 0.92–1.62).ConclusionOropharyngeal administration of colostrum can reduce the incidence of NEC, LOS, and VAP in preterm infants, shortening the time to reach full enteral feeds, and duration of hospital stay, and increasing the rate of weight gain (kg.d). Therefore, OAC can be used as part of routine care for preterm infants.

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Section: Discussionmentioning

confidence: 99%

Intervention Effect of Oropharyngeal Administration of Colostrum in Preterm Infants: A Meta-Analysis

et al. 2022

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“…As previously acknowledged, the research on the extremely preterm or ELBW population is less concrete compared to larger infants, such as those born VLBW (<1500 g) or even at low birth weights (<2500 g). This is likely due to the smaller number of ELBW infant births, the inclusion of growth-restricted infants who are ELBW but not extremely preterm, the general variability in acuity after birth, and the increased challenges of conducting clinical research [ 4 , 26 , 27 ]. While quandaries may also exist in older or larger populations, these are less helpful in a more extreme population and when results may not be fully extrapolated.…”

Section: Current Evidencementioning

confidence: 99%

“…The variability of the available literature is exemplified in regard to enteral feeding management. For instance, in VLBW infants (which also includes subsets of ELBW infants), a 2022 Cochrane review revealed that delaying the introduction of enteral feedings has no impact on the risk of developing necrotizing enterocolitis [ 27 ]. Likewise, the delayed introduction of enteral feedings results in intestinal villous atrophy [ 28 , 29 ] and prolongs the duration to achieve full enteral feeding [ 27 ].…”

Section: Current Evidencementioning

confidence: 99%

“…For instance, in VLBW infants (which also includes subsets of ELBW infants), a 2022 Cochrane review revealed that delaying the introduction of enteral feedings has no impact on the risk of developing necrotizing enterocolitis [ 27 ]. Likewise, the delayed introduction of enteral feedings results in intestinal villous atrophy [ 28 , 29 ] and prolongs the duration to achieve full enteral feeding [ 27 ]. Similarly, a 2021 Cochrane review concluded that smaller advancements of enteral feeding volumes compared with higher volumes do not reduce the risk of necrotizing enterocolitis or death in VLBW infants [ 26 ].…”

Section: Current Evidencementioning

confidence: 99%

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Nutrition Support Practices for Infants Born <750 Grams or <25 Weeks Gestation: A Call for More Research

Thoene

Anderson‐Berry

2022

IJERPH

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“…3 Recent randomized clinical trials (RCTs) evaluating enteral feeding initiation and/or advancements have demonstrated benefits such as reduction in the use of parenteral nutrition, the need for central venous access, and the risk of invasive infections, all without any increase in risk of SIP or NEC. [4][5][6][7][8] Following the clear and significant benefits inferred from early use of human milk for VLBW infants, 9 the practice of providing trophic feeding has been largely accepted. However, practices regarding the ideal time for initiation of enteral feeding, the duration and volume of initial feedings, and the rate of progression of feeding volumes to establish full enteral feeding among VLBW infants are widely variable.…”

Section: Introductionmentioning

confidence: 99%

Advancement of Enteral Feeding in Very-low-birth-weight Infants: Global Issues and Challenges

Nangia¹,

Maheshwari²,

Valentine³

et al. 2022

Newborn

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In very-low-birth-weight (VLBW) infants, the initiation of enteral feedings is frequently delayed and the feeding volumes are advanced very slowly. Clinicians often express concerns about gut immaturity and consequent increased risk of feeding intolerance, spontaneous intestinal perforation (SIP), and necrotizing enterocolitis (NEC). Late initiation and ultracautious advancement of enteral feedings are seen all over the world, despite known associations with a prolonged need for central venous access and increased risk of sepsis, which is one of the leading causes of neonatal mortality. Promoting early establishment of full enteral feeding, particularly when maternal or donor milk is available, can improve neonatal outcomes, particularly the incidence of central-line-associated bacterial infections, the length of hospital stay, and survival. This review highlights current evidence for maximizing enteral feeding strategies for VLBW infants in various settings. Specifically, we will outline the physiologic evidence for early and continued enteral feedings in VLBW infants, discuss considerations for the initiation and advancement of enteral feedings, and highlight future areas of research focused on these issues. Consideration for the evidence from low-as well as highresource settings is critical to inform optimal feeding strategies of VLBW infants globally.

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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 24 publications

References 83 publications

Intervention Effect of Oropharyngeal Administration of Colostrum in Preterm Infants: A Meta-Analysis

Intervention Effect of Oropharyngeal Administration of Colostrum in Preterm Infants: A Meta-Analysis

Nutrition Support Practices for Infants Born <750 Grams or <25 Weeks Gestation: A Call for More Research

Advancement of Enteral Feeding in Very-low-birth-weight Infants: Global Issues and Challenges

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