Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants

Abstract

This is a repository copy of Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants.

Compatibility of rapid enteral feeding advances and noninvasive ventilation in preterm infants—An observational study

“…Our data on somatic growth until discharge might argue toward an additional benefit of rapid feeding increments for the lung what might be mirrored in the trend toward reduced risk for BPD in infants between 500 and 999 g of BW. In the literature, advancing the volume of enteral feeds at a slow rate resulted in several days of delay in establishing full enteral feeds, may increase the risk of invasive infection and higher risk of BPD 17,23,38 . The trend toward a reduced risk for nosocomial infections in our rapid enteral feeding advances group might have as well contributed to the trend of reduced BPD in the infants born 500–1000 g BW (Table ).…”

“…Unfortunately, the connection between early and progressive enteral feeding and NEC incidence has resulted in prolonged duration of intravenous nutrition in infants, potentially increasing the risk of infectious complications and the length of hospitalization which in turn increases the risk for BPD 29 . A recent Cochrane analysis comparing 10 randomized controlled trials (RCTs) ( n = 3753) did not provide evidence that slow advancements reduce the risk of NEC (typical relative risk [RR]: 1.07, 95% confidence interval [CI]: 0.83–1.39; risk difference [RD]: 0.0, 95% CI: −0.01 to 0.02) or all‐cause mortality (typical RR: 1.15, 95% CI: 0.93–1.42; typical RD: 0.01, 95% CI: −0.01 to 0.03) 17 . In our cohort the cumulative incidence of NEC was much lower (1.0%; n = 2 before and n = 1 after implementation of STENA) than in the before‐mentioned studies but did not differ significantly before and after STENA implementation (Table 2).…”

“…Taken together our data confirm current evidence about the safety of rapid enteral feeding advances in preterm infants. Reducing the duration of parenteral nutrition has many theoretical advantages, but besides shortening of iv access and lengths of hospital stay, little advantage has been documented despite the potentially higher risk of acquiring a severe infection 17 . In contrast, there are still major concerns of rapid feeding advances with respect to NEC and other morbidities.…”

“…However, conservative feeding regimes delay establishment of full enteral feeding and extend exposure to parenteral nutrition increasing the risk for late‐onset sepsis, which in turn is a major risk factor for BPD 15,16 . The recently published Cochrane analysis of randomized controlled trials indicates no significant effects of rapid versus slow feeding advances in the risk of NEC or all‐cause mortality and no difference in survival without moderate or severe neurodevelopmental disability at 24 months 17,18 . Moreover, a significant delay in establishment of full enteral feeding and regain of birthweight (BW) were reported for slow advancement.…”

Postoperative feeding in neonatal duodenal obstruction

“…Randomized controlled trials (RCT) demonstrate the efficacy and safety of ‘fast feeding’ with advancing rates of some 30–40 ml/kg/day achieved in neonates particularly in an effort to reduce risks of NEC [ 5 , 10 ]. Gavage-feeds [ 8 ] or oral-feeds can thus also be considered in the preterm or very low birthweight infant.…”