Multi-modal approach to prophylaxis of necrotizing enterocolitis: clinical report and review of literature

Abstract

For the first time a multimodal approach to NEC prophylaxis is reported, consisting of early trophic feeding with human breast milk, and enteral administration of an antibiotic, an antifungal agent, and probiotics. A retrospective analysis of local protocol of NEC prophylaxis is presented. Included were all VLBWI admitted to the NICU, including transfers within the first 28 days of life. These infants were divided into two groups, an "inborn group" (infants admitted within the first 24 h of life) and an "outborn group" (infants admitted after the onset of their second day of life). Prophylaxis of NEC according to protocol was started at the day of admission, and was continued until discharge. Between 1998 and 2004, 405 VLBWI were admitted, including all transfers within the first 28 days of life. A total of 334 (82%) infants were admitted within the first 24 h of life (inborn group), and 71 (18%) were admitted after 24 h of life (outborn group). Five infants developed clinical features of necrotizing enterocolitis. The inborn group showed a NEC incidence of 0.7% (two infants), whereas the outborn group showed a NEC incidence of 4.5% (three infants), respectively. This difference was significant (P=0.049, Fisher's exact test). A surgical treatment with bowel resection was performed in two infants (both from the outborn group). The present study used a combination of different strategies, all having shown to have some beneficial effect, but not having brought a clinical breakthrough in single administration studies. Combinated were the beneficial effects of human breast milk feeding, oral antiobiotics, oral antifungal agents, and the administration of probiotics. In a homogenous group of preterm infants, using this protocol of multimodal NEC prophylaxis, there was a very low incidence of NEC, when started within the first 24 h of life.

Prophylactic Probiotics for Preterm Infants: A Systematic Review and Meta-Analysis of Observational Studies

“…In a retrospective analysis Schmolzer et al [30] found a statistically significant decreased risk of NEC in the group receiving early NEC prophylaxis (e.g. antibiotics, probiotics).…”

Efficacy of a Triple Anti-Infective Regimen for Prevention of Complications in Critically Ill Term Neonates

“…Our longlasting experience in the use of enteral gentamycin has revealed neither a change in ESBL producing enterobacteria in stool surveillance cultures nor in antimicrobial sensitivity patterns (22). This is also the case for the use of LCR resulting in very low NEC rates as compared to other studies (16).…”

“…As far as our prophylactic multimodal, anti-infective regimen resulted in very low NEC rates (16) we felt that a placebo controlled trial might be unethical. Hence, we compared our complication rates to the published evidence in term critically ill neonates.…”

“…All neonates received a standardized prophylactic multi-modal, anti-infective treatment with enteral probiotics, antifungal agents, and enteral gentamycin starting at the first day of life and ending at discharge (16 Outcome parameters were checked for in all medical records of the neonates using the electronic patient data monitoring system (PDMS, Sanitas, Austria) at the NICU as follows:…”

“…Aim of the study was to evaluate a prophylactic multimodal anti-infective regimen (16) given within 24 hours of age in critically ill full-term neonates by means of a retrospective observational STROBE compliant single-center cohort study. Our hypothesis was that this regimen might lead to lower complication rates than reported elsewhere.…”