Time to reintroduction of feeding in infants with nonsurgical necrotizing enterocolitis

Arbra, Chase A; Oprisan, Andra; Wilson, Dulaney A.; Ryan, Rita M.; Lesher, Aaron

doi:10.1016/j.jpedsurg.2018.02.082

Cited by 27 publications

(20 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Only the study by Brotschi et al [15] mentioned the timing of recurrence from initial NEC episode, which was after full enteral feedings were reestablished, therefore it is unclear if recurrence was related to when enteral feeds were re-intiated. In all three studies [12,14,15] included in the meta-analysis, the odds of a CLABSI were significantly lower and full feedings were achieved significantly earlier in the earlier refeeding group once feeds were restarted. The earlier refeeding group overall had a lower incidence of recurrence, although not statistically significant compared with the later refeeding group.…”

Section: Discussionmentioning

confidence: 95%

“…A previous meta-analysis by Hock et al [16] included only two of the three studies we identified as eligible for this current meta-analysis. The third singlecenter study [12] was published after the Hock et al…”

Section: Study Characteristicsmentioning

confidence: 99%

“…All studies evaluated incidences of recurrent NEC and post-NEC stricture (Supplementary Information Table 3). After removal of Stage I infants, the earlier enteral feeding group from the Arbra study [12] had 23 infants in the earlier refeeding group and 84 infants in the later refeeding group. Then with the three studies combined, there was a total of 198 infants, 79 infants in the earlier re-initiation of enteral feeding group and 119 infants in the later feeding group (Table 2).…”

Section: Study Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

Earlier re-initiation of enteral feeding after necrotizing enterocolitis decreases recurrence or stricture: a systematic review and meta-analysis

Patel¹,

Wilson

Brennan

et al. 2020

J Perinatol

Self Cite

View full text Add to dashboard Cite

Objective To assess the effects of earlier vs. later re-initiation of enteral feeds after necrotizing enterocolitis (NEC). Study design We reviewed the literature to assess timing of enteral feeding after NEC using fixed effects models. Results Three studies met inclusion criteria; no randomized trials. After removal of Bell's Stage I infants, the earlier refeeding group (<5-7 or median 4 days) included 79 infants and later refeeding group (≥5-7 or median 10 days) included 119 infants. Pooled analysis revealed earlier re-initiation reduced the incidence in the composite outcome of recurrent NEC and/or post-NEC stricture (OR = 0.27; 95% Cl = 0.10-0.75; p = 0.012). Individually, NEC recurrence (pooled OR = 0.34; 95% Cl = 0.09-1.29; p = 0.112) or stricture (OR = 0.34; 95% Cl = 0.09-1.26; p = 1.06) did not differ between groups. Conclusions There was no increase in negative outcomes with earlier refeeding after NEC. Earlier initiation of enteral feeds resulted in a significantly lower risk for the combined outcome of recurrent NEC and/or post-NEC stricture.

show abstract

Section: Discussionmentioning

confidence: 95%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

Earlier re-initiation of enteral feeding after necrotizing enterocolitis decreases recurrence or stricture: a systematic review and meta-analysis

Patel¹,

Wilson

Brennan

et al. 2020

J Perinatol

Self Cite

View full text Add to dashboard Cite

show abstract

“…22 Furthermore, the exact duration of bowel rest in infants with non-surgical necrotising enterocolitis is based on disease severity and clinical judgement. 23 In this study, the median calprotectin concentrations were significantly different between neonates with and without necrotising enterocolitis.…”

Section: Discussionmentioning

confidence: 51%

Faecal calprotectin concentrations in neonates with CHD: pilot study

O’Connor

Brown

2020

Cardiol Young

View full text Add to dashboard Cite

Neonates with CHD are at increased risk of developing necrotising enterocolitis due to mesenteric hypoperfusion. Necrotising enterocolitis results in repeated feed interruptions contributing to poor growth during the early post-operative phase. Poor weight gain and longer hospital stay are risk factors for death in neonates with CHD. Abdominal radiography is used as a diagnostic tool for necrotising enterocolitis; however, its utility is limited in the early stages of necrotising enterocolitis when pneumatosis intestinalis is absent. Calprotectin is a neutrophil activation biomarker, and elevated levels are evident in inflammatory diseases such as necrotising enterocolitis. The aim of this study was to determine whether there is a correlation between faecal calprotectin concentration and gut inflammation in neonates with CHD. This prospective single-centre study recruited newly diagnosed term patients with duct-dependent CHD between March 2018 and March 2019. Faecal calprotectin concentrations were measured in post-surgical patients using enzyme-linked immunosorbent assay methods. A total of 30 patients were included in the analysis. Calprotectin concentration for patients who developed necrotising enterocolitis was 3528 µg/g compared with 390 µg/g without, compared with 1339 µg/g in patients with suspected necrotising enterocolitis (p = 0.0001). Patients with suspected necrotising enterocolitis had a significantly longer length of hospital stay, on average 18 days longer compared to patients without necrotising enterocolitis (p = 0.03). Faecal calprotectin concentrations may reflect severity of gut inflammation in neonates with CHD. Suspected necrotising enterocolitis contributes to longer days nil by mouth and an increase in length of hospital stay.

show abstract

“…In significantly preterm infants advancing the volume of enteral feeds at a slow rate results in several days of delay in establishing full enteral feeds and may increase the risk of invasive infection, 13 delaying the introduction of progressive enteral feeds beyond 4 days after birth did not reduce the risk of developing necrotising enterocolitis in very preterm infants 14 and in medical necrotising enterocolitis managed non-operatively, early reintroduction of feeding was not significantly associated with complications. 15 Enhanced recovery after surgery guidelines state that patients undergoing total gastrectomy should be offered drink and food at will from postoperative day 1 16 and most patients after bowel resection should be offered food from the day of surgery. 17 These recommendations provide strong underpinning to the practice that even after major alimentary tract resection and the presence of surgical anastomosis, significant resting of the gut from oral feeding is unnecessary.…”

Section: Discussionmentioning

confidence: 99%

Twelve‐hour fasting compared with expedited oral intake in the initial inpatient management of hyperemesis gravidarum: a randomised trial

Tan

Abdussyukur

Lim

et al. 2020

BJOG

View full text Add to dashboard Cite

Objective To evaluate fasting for 12 hours compared with expedited oral feeding in hospitalised women with hyperemesis gravidarum (HG). Design Randomised trial. Setting University Hospital, Malaysia: April 2016–April 2017. Population One hundred and sixty women hospitalised for HG. Method Women were randomised upon admission to fasting for 12 hours or expedited oral feeding. Standard HG care was instituted. Main outcome measure Primary outcome was satisfaction score with overall treatment at 24 hours (0–10 Visual Numerical Rating Scale VNRS), vomiting episodes within 24 hours and nausea VNRS score at enrolment, and at 8, 16 and 24 hours. Results Satisfaction score, median (interquartile range) 8 (5–9) versus 8 (7–9) (P = 0.08) and 24‐hour vomiting episodes were 1 (0–4) versus 1 (0–5) (P = 0.24) for 12‐hour fasting versus expedited feeding, respectively. Repeated measures analysis of variance of nausea scores over 24 hours showed no difference (P = 0.11) between trial arms. Participants randomised to 12‐hour fasting compared with expedited feeding were less likely to prefer their feeding regimen in future hospitalisation (41% versus 65%, P = 0.001), to recommend to a friend (65% versus 84%, P = 0.01; RR 0.8, 95% CI 0.6–0.9) and to adhere to protocol (85% versus 95%, P = 0.04; RR 0.9, 95% CI 0.8–1.0). Symptoms profile, ketonuria status at 24 hours and length of hospital stay were not different. Conclusion Advisory of 12‐hour fasting compared with immediate oral feeding resulted in a non‐significant difference in satisfaction score but adherence to protocol and fidelity to and recommendation of immediate oral feeding to a friend were lower. The 24‐hour nausea scores and vomiting episodes were similar. Tweetable abstract Women hospitalised for hyperemesis gravidarum could feed as soon, as much and as often as can be tolerated compared with initial fasting.

show abstract

Time to reintroduction of feeding in infants with nonsurgical necrotizing enterocolitis

Cited by 27 publications

References 23 publications

Earlier re-initiation of enteral feeding after necrotizing enterocolitis decreases recurrence or stricture: a systematic review and meta-analysis

Earlier re-initiation of enteral feeding after necrotizing enterocolitis decreases recurrence or stricture: a systematic review and meta-analysis

Faecal calprotectin concentrations in neonates with CHD: pilot study

Twelve‐hour fasting compared with expedited oral intake in the initial inpatient management of hyperemesis gravidarum: a randomised trial

Contact Info

Product

Resources

About