Time to Full Enteral Feeding for Very Low‐Birth‐Weight Infants Varies Markedly Among Hospitals Worldwide But May Not Be Associated With Incidence of Necrotizing Enterocolitis: The NEOMUNE‐NeoNutriNet Cohort Study

Abstract

Background Transition to enteral feeding is difficult for very low‐birth‐weight (VLBW; ≤1500 g) infants, and optimal nutrition is important for clinical outcomes. Method Data on feeding practices and short‐term clinical outcomes (growth, necrotizing enterocolitis [NEC], mortality) in VLBW infants were collected from 13 neonatal intensive care units (NICUs) in 5 continents (n = 2947). Specifically, 5 NICUs in Guangdong province in China (GD), mainly using formula feeding and slow feeding advancement (n = 1366), were compared with the remaining NICUs (non‐GD, n = 1581, Oceania, Europe, United States, Taiwan, Africa) using mainly human milk with faster advancement rates. Results Across NICUs, large differences were observed for time to reach full enteral feeding (TFF; 8–33 days), weight gain (5.0–14.6 g/kg/day), ∆z‐scores (−0.54 to −1.64), incidence of NEC (1%–13%), and mortality (1%–18%). Adjusted for gestational age, GD units had longer TFF (26 vs 11 days), lower weight gain (8.7 vs 10.9 g/kg/day), and more days on antibiotics (17 vs 11 days; all P < .001) than non‐GD units, but NEC incidence and mortality were similar. Conclusion Feeding practices for VLBW infants vary markedly around the world. Use of formula and long TFF in South China was associated with more use of antibiotics and slower weight gain, but apparently not with more NEC or higher mortality. Both infant‐ and hospital‐related factors influence feeding practices for preterm infants. Multicenter, randomized controlled trials are required to identify the optimal feeding strategy during the first weeks of life.

Microbiota Supplementation with Bifidobacterium and Lactobacillus Modifies the Preterm Infant Gut Microbiota and Metabolome: An Observational Study

“…Extremely low-birth-weight infants (<1,000 g) represented the most vulnerable cohort in this study and presented less abundance of genus Bifidobacterium , potentially due to several factors including, lengthened antibiotic courses, 39 underdeveloped gut physiology (i.e., poorer gut motility, and thinner mucus layer 40 ), and difficulties in establishing full enteral feeding. 41 Indeed, previous clinical studies have had difficulties evaluating the beneficial effects of supplementation in this at-risk cohort of preterm infants, 42 while others have seen a reduction in LOS but not in NEC. 42 , 43 Notably, although extremely low-birth-weight Bif/Lacto infants had lower Bifidobacterium abundance than those infants weighing 1,000 g, supplementation in our study did enhance levels when compared to control infants.…”

Single-course antenatal corticosteroids is related to faster growth in very-low-birth-weight infant

“…The retrospective cohort study was a part of the NEOMUNE study [ 21 ], which was performed in five neonatal intensive care units (NICUs) from 2011 to 2014 in Guangdong province, China. Inclusion criteria were infants inborn or transferred to the NICU within 24 h after birth, < 37 weeks’ gestation and < 1500 g at birth, survived for at least 24 h. Exclusion criteria included major congenital abnormalities or congenital metabolic diseases.…”

Supplemental Insulin-Like Growth Factor-1 and Necrotizing Enterocolitis in Preterm Pigs

“…The same study showed no effect on the overall incidence of necrotizing enterocolitis (NEC) (6/61 vs. 5/60), but the number of fatal NEC cases was highest in the rhIGF-1/BP-3 group (3 vs. 0). Generally, NEC is associated with high mortality (20–30%) and occurs in 5–10% of extremely preterm infants within the first weeks of life ( 18 – 22 ). Despite comprehensive research, in part using animal models, the pathogenesis of NEC remains ambiguous and worldwide the NEC incidence is constant or increasing ( 19 , 21 ).…”