Early enteral feeding in conservatively managed stage II necrotizing enterocolitis is associated with a reduced risk of catheter-related sepsis

Abstract

Aims: To compare the effect of fasting period duration on complication rates in neonates managed conservatively for necrotizing enterocolitis (NEC) Bell stage II. Methods: We conducted a multicenter study to analyze retrospectively multiple data collected by standardized questionnaire on all admissions for NEC between January 2000 and December 2006. NEC was staged using modified Bell criteria. We divided the conservatively managed neonates with NEC Bell stage II into two groups (those fasted for -5 days and those fasted for )5 days) and compared the complication rates. Results: Of the 47 conservatively managed neonates Bell stage II, 30 (64%) fasted for -5 days (range 1-4 days) and 17 (36%) for )5 days (range 6-16 days). There were no significant differences for any of the patient characteristics analyzed. One (3%) and four (24%) neonates, respectively, developed post-NEC bowel stricture. One (3%) and two neonates (12%) suffered NEC relapse. None and five (29%) neonates developed catheter-related sepsis. Conclusion: Shorter fasting after NEC appears to lower morbidity after the acute phase of the disease. In particular, shorter-fasted neonates have significantly less catheter-related sepsis. We found no benefit in longer fasting.

Initiation of Enteral Feeding After Necrotizing Enterocolitis

“…One single-center study took place in Germany, 10 and the other was multicenter and undertaken in Switzerland. 9 NEC diagnosis was based on Bell's staging criteria in both included studies, with a stage of 2 or above considered to be NEC. One study included only medically managed neonates (no surgery), 9 whereas the other consisted of both medically and surgically treated infants with NEC.…”

“…9 NEC diagnosis was based on Bell's staging criteria in both included studies, with a stage of 2 or above considered to be NEC. One study included only medically managed neonates (no surgery), 9 whereas the other consisted of both medically and surgically treated infants with NEC. 10 The feeding regimes varied among studies as outlined in ►Table 1.…”

“…7 One study has shown that introduction of enteral feeds within 10 days of the initial NEC diagnosis causes NEC recurrence 8 ; however, other studies have reported no association between NEC recurrence and timing of introduction of enteral feeding after NEC. 5,9,10 To determine the optimal timing of enteral feeding initiation after NEC diagnosis, we performed a systematic review and meta-analysis to compare early with delayed enteral feed initiation on the incidence of NEC recurrence, and additional adverse outcomes, such as rates of catheter-related sepsis and post-NEC bowel stricture.…”

Terapia nutricional e sepse neonatal

“…(55) Additionally, Brotschi et al showed that early achievement of full EN will reduce the incidence of catheter-related sepsis. (56) However, as highlighted by some investigations, currently, the benefits and risks of trophic nutrition and full EN are not well-established. Therefore, the results are still insufficient to provide clear clinical practice guidance.…”

Risk factors of mild rectal bleeding in very low birth weight infants: a case control study

“…This is unfortunate as it may have a significant impact on neonatal care because the management sometimes requires a fasting period [3], with possible need to start or extend parenteral nutrition, which increases the risk of catheter-related sepsis [7,8]. …”