Rapid versus slow rate of advancement of feedings for promoting growth and preventing necrotizing enterocolitis in parenterally fed low-birth-weight infants

Ka, Kennedy; Tyson, JE

doi:10.1002/14651858.cd001241

Cited by 59 publications

(42 citation statements)

References 15 publications

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“…Finally, because we used standardized schedules for advancing feeds, it is impossible to evaluate the clinical benefits of faster rates of EN advancement as reported by others. 18,21 In summary, results demonstrate a period of critical risk for LOB likely due to the relative importance and bacterial colonisation momentum occurring with CoNS soon after birth. Benefits from earlier initiation of EN observed in the subgroup of most mature VLBW neonates are likely to result from a threshold effect between the timing of CoNS and duration of PN.…”

Section: Discussionmentioning

confidence: 84%

“…Interventional studies on feeding practices are methodologically complex to conduct. 15,21 In the mean time, well-powered observational studies, such as results presented here, can be extremely informative for focusing the design of such trials. Of note, the relative incidence of CoNS reported here is high compared to that previously reported, although the overall incidence of LOB is similar.…”

Section: Discussionmentioning

confidence: 96%

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Earlier initiation of enteral nutrition is associated with lower risk of late-onset bacteremia only in most mature very low birth weight infants

Lavoie

2009

J Perinatol

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Objective: To examine the temporal relationship between early enteral nutrition (EN) and coagulase-negative staphylococcal (CoNS)-related lateonset bacteremia (LOB) in very low birth weight (VLBW) neonates.Study Design: Multivariate analyses performed on a large retrospective cohort of neonates admitted to a tertiary care neonatal unit.Results: Due to the predominance and particular timing of CoNS, LOB occurred mostly during a critical period peaking at 9 days of age. This period also corresponded to a gestational maturation-dependent breakpoint in time to achieve full EN, associated with significant reduction in incidence of bacteremia (adjusted OR 0.15; 95%CI [0.10-0.20]; P<0.05). In subgroup analyses, more 'mature' (i.e. X28 and <32 weeks) preterm neonates reached full EN before this critical period and consequently, earlier EN in this group was associated with a shorter duration of PN and reduced incidence of CoNS bacteremia. In contrast, most 'immature' preterm neonates (i.e. <28 weeks) generally received PN beyond this critical period and therefore, did not appear to benefit from earlier initiation of EN. Even though EN was usually initiated earlier when formula milk was used as a complement to breast-milk, this practice was not associated with a reduction in the incidence of CoNS in any preterm gestational groups tested. Conclusion:A reduction in incidence of bacteremia was observed only in more mature VLBW neonates who achieved full EN before the secondweek of life critical period for CoNS, These results provide important endpoints for future trials evaluating changes in nutritional interventions potentially effective in reducing neonatal LOB.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 96%

Earlier initiation of enteral nutrition is associated with lower risk of late-onset bacteremia only in most mature very low birth weight infants

Lavoie

2009

J Perinatol

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“…[3][4][5][6][7][8][9][10][11][12][13][14] Many authors have focused on a single factor rather than exploring the additive effects of several factors. Our review of the literature revealed no recent studies with sufficient cohort size to evaluate the relation between multiple factors for NEC.…”

Section: Introductionmentioning

confidence: 99%

Necrotizing Enterocolitis Among Neonates in the United States

et al. 2003

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BACKGROUND:Prior studies have identified individual risk factors that are associated with necrotizing enterocolitis (NEC); however, the small sample sizes of these previous studies have not allowed the analysis of potential interaction between multiple variables and NEC. Our purpose was to describe the incidence and risk factors for NEC in premature neonates admitted for intensive care. METHODS:We identified neonates as having NEC if they met accepted diagnostic criterion for necrotizing enterocolitis. Using a national database, we assessed the association between NEC and a battery of risk factors previously reported in peer-reviewed literature. RESULTS:There were 15,072 neonates that met inclusion criteria; 14,682 did not have NEC, while 390 (2.6%) met criterion for NEC. Multivariate analysis showed that low birth weight was the most important risk factor for NEC. Other factors that were associated with an increased risk of NEC were exposure to antenatal glucocorticoids, vaginal delivery, need for mechanical ventilator support, exposure to both glucocorticoids and indomethacin during the first week of life, absence of an umbilical arterial catheter, and low Apgar score at 5 minutes. Length of hospital stay and mortality were higher in neonates with NEC than in neonates without NEC. CONCLUSIONS:NEC remains an important cause of morbidity and mortality in prematurely born neonates. In contrast to previous studies, we found that exposure to antenatal glucocorticoids was associated with an increased risk for NEC independent of birth weight.

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“…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

“…Además, algunos estudios han encontrado que el inicio temprano de la vía oral no aumenta el riesgo de enterocolitis (16,17). Igualmente, se discute el papel que podría jugar la velocidad en los incrementos de la vía oral (18), aunque algunos estudios no encuentran relación alguna (19,20).…”

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Incidencia de enterocolitis necrosante en niños prematuros alimentados precozmente

et al. 2011

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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...

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Rapid versus slow rate of advancement of feedings for promoting growth and preventing necrotizing enterocolitis in parenterally fed low-birth-weight infants

Cited by 59 publications

References 15 publications

Earlier initiation of enteral nutrition is associated with lower risk of late-onset bacteremia only in most mature very low birth weight infants

Earlier initiation of enteral nutrition is associated with lower risk of late-onset bacteremia only in most mature very low birth weight infants

Necrotizing Enterocolitis Among Neonates in the United States

Incidencia de enterocolitis necrosante en niños prematuros alimentados precozmente

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