Incidence of necrotizing enterocolitis among preterm newborns with early feeding. A clinical trial
Keywords:
enterocolitis necrosante, alimentación entérica, leche humana, recién nacido.
Abstract
Introduction. Necrotizing enterocolitis is a multifactorial catastrophe to newborns; it is caused by splacnich bed vasoconstriction that produce intestinal necrosis. The role of onset time, type and, speed enhancements of enteral feeding related with necrotizing enterocolitis genesis are discussed today.Objective. To compare the incidence of necrotizing enterocolitis and mortality among infants in whom enteral feeding was started 48 hours after birth compared to others that began on the fifth day of life.
Materials and methods. Controlled clinical trial was conducted among 239 newborns between 750 to 1.500 g and 27-32 weeks of gestational age, randomly assigned 135 to early feeding and 104 to delayed feeding; breast milk or formula milk for infants were used. Feeding began with one mL every six hours, to progress at three hours intervals daily and increased to 20 mL/kg-d to reach 150 mL/kg-d while any patient remained stable and showed no oral intolerance manifestations.
Results. There were 14 necrotizing enterocolitis cases in early feeding group (10.4%) and nine (8.7%) in late feeding one (RR= 1.22, 95% CI 0.49-3.20, p= 0.652). Five children died in early feeding group (3.7%, 95% CI 1.4-8.9) and eight in late feeding one (7.7%, 95% CI 3.6-15.0, RR= 0.46, 95% CI 0.12-1,60, p= 0.182).
Conclusion. The start in early enteral feeding in preterm newborns does not increase the risk of necrotizing enterocolitis or mortality among them, and does represent great advantages for these patients.
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References
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2. Hsuell W, Caplan MS, Qu XW, Tan XD, Depluen IG, Gonzalez-Crussi F. Neonatal necrotizing enterocolitis: Clinical considerations and pathogenic concepts. Pediatr Dev Pathol. 2003;6:6-23.
3. Covert RF, Neu J, Elliott MJ, Rea JL, Gimotty PA. Factors associated with age of onset of necrotizing enterocolitis. Am J Perinatol. 1989;6:455-60.
4. Stoll BJ. Epidemiology of necrotizing enterocolitis. Clin Perinatol. 1994;21:205-18.
5. Llanos AR, Moss ME, Pinzón MC, Dye T, Sinkin RA, Kendig JW. Epidemiology of neonatal necrotizing enterocolitis; a population-based study. Paeditr Perinat Epidemiol. 2002;16:342-9.
6. Doring J, Kempley S, Leaf A. Feeding growth restricted preterm infants with abnormal antenatal Doppler results. Arch Dis Child Fetal Neonatal Ed. 2005;90:359-63.
7. Anderson DM, Kliegman RM. The relationship of neonatal
alimentation practices to the occurrence of endemic necrotizing enterocolitis. Am J Perinatol. 1991;8:62-7.
8. Berseth CJ. Feeding strategies and necrotizing enterocolitis. Curr Opin Pediatr. 2005;17:170-3.
9. Martin CR, Walker WA. Intestinal immune defenses and the inflammatory response in necrotizing enterocolitis. Sem Fetal Neonatal Med. 2006;11:e369-77.
10. Neu J. The "myth" of asphyxia and hypoxia-ischemia as primary causes of necrotizing enterocolitis. Biol Neonate. 2005;87:97-8
11. Lin PW, Narsr TR, Stoll BS. Necrotizing enterocolitis: Recent scientific advances in pathophysiology and prevention. Semin Perinatol. 2008:32;70-82.
12. Spritzer R, Koolen AM, Baerts W, Fetter WP, Lafeber HN, Sauer PJ. A prolonged decline in the incidence of necrotizing enterocolitis after the introduction of a cautions feeding regimen. Acta Paediatr Scand. 1988;77:909-11.
13. Brown EG, Sweet AY. Preventing necrotizing enterocolitis in neonates. JAMA. 1978;240:2452-4.
14. Berseth CL. Effect of early feeding on maturation of the preterm infant's small intestine. J Pediatr. 1992;120:947-53.
15. Berseth CL, Nordyke C. Enteral nutrients promote postnatal maturation of intestinal motor activity in preterm infants. Am J Physiol. 1993;264:G1046-51.
16. McClure RJ, Newell SJ. Randomized controlled study of clinical outcome following trophic feeding. Arch Dis Child Fetal Neonatal Ed. 2000;82:F29-33.
17. Tyson JE, Kennedy KA. Minimal enteral nutrition in parenterally fed neonates. Cochrane Database Syst Rev. 2000;(2):CD000504. Update in: Cochrane Database Syst Rev. 2005;(3):CD000504.
18. Kennedy KA, Tyson JE, Chamnanvanakij S. Rapid versus slow rate of advancement of feedings for promoting growth and preventing necrotizing enterocolitis in parenterally fed low-birth-weight infants. Cochrane Database Syst Rev. 2000;(2):CD001241. Update in: Cochrane Database Syst Rev. 2008;(2):CD001241.
19. Book LS, Herbst JJ, Jung AL. Comparison of fast and slow feeding rate schedules to the development of necrotizing enterocolitis. J Pediatr. 1976;89:463-6.
20. Rayyis SF, Ambalavanan N, Wright L, Carlo WA. Randomized trial of "slow" versus "fast" feed advancements on the incidence of necrotizing enterocolitis in very low birth weight infants. J Pediatr. 1999;34:293-7.
21. Walsh MC, Kliegman RM. Necrotizing enterocolitis: Treatment based on staging criteria. Pediatr Clin North Am. 1986;33:179-201.
22. LaGamma EF, Ostertag SG, Birenbaum H. Failure of delayed oral feedings to prevent necrotizing enterocolitis. Results of study in very-low-birth-weight neonates. Am J Dis Child. 1985;139:385-9.
23. Okada Y, Klein N, Pierro A. Small volumes of enteral feedings normalize immune function in infants receiving parenteral nutrition. J Pediatr Surg. 1998;33:16-9.
24. Book LS, Herbsf JJ, Jung AL. Comparison of fast and slow feeding rate schedules to the development of necrotizing enterocolitis. J Pediatr. 1976;89:463-6.
25. Caple J, Armentrout D, Huseby V, Halbardier B, García J, Sparks JW, et al. Randomized controlled trial of slow versus rapid feeding volume advancement in preterm infants. J Pediatr. 2004;114:1597-600.
26. Henderson G, Craig S, Brocklehurst P, McGuire W. Enteral feeding regimens and necrotizing enterocolitis in preterm infants: Multicentre case-control study. Arch Dis Child Fetal Neonatal Ed. 2007;94:120-3.
27. Patole SK, de Klerk N. Impact of standardized feeding regimens on incidence of neonatal necrotizing enterocolitis: A systematic review and meta-analysis of observational studies. Arch Dis Child Fetal Neonatal Ed. 2005;90:F147-51.
28. Henderson G, Craig S, Brucklehurst P, McGuire W. Enteral feeding regimens and necrotizing enterocolitis in preterm infants: A multicenter case-control study. Arch Dis Child Fetal Neonatal Ed. 2009;94:F120-3
29. Berseth CL, Bisquera JA, Pafe VU. Prolonging small feeding volumes early in life decreases the incidence of necrotizing enterocolitis in very low birth weight infants. Pediatrics. 2003;11:529-34.
2. Hsuell W, Caplan MS, Qu XW, Tan XD, Depluen IG, Gonzalez-Crussi F. Neonatal necrotizing enterocolitis: Clinical considerations and pathogenic concepts. Pediatr Dev Pathol. 2003;6:6-23.
3. Covert RF, Neu J, Elliott MJ, Rea JL, Gimotty PA. Factors associated with age of onset of necrotizing enterocolitis. Am J Perinatol. 1989;6:455-60.
4. Stoll BJ. Epidemiology of necrotizing enterocolitis. Clin Perinatol. 1994;21:205-18.
5. Llanos AR, Moss ME, Pinzón MC, Dye T, Sinkin RA, Kendig JW. Epidemiology of neonatal necrotizing enterocolitis; a population-based study. Paeditr Perinat Epidemiol. 2002;16:342-9.
6. Doring J, Kempley S, Leaf A. Feeding growth restricted preterm infants with abnormal antenatal Doppler results. Arch Dis Child Fetal Neonatal Ed. 2005;90:359-63.
7. Anderson DM, Kliegman RM. The relationship of neonatal
alimentation practices to the occurrence of endemic necrotizing enterocolitis. Am J Perinatol. 1991;8:62-7.
8. Berseth CJ. Feeding strategies and necrotizing enterocolitis. Curr Opin Pediatr. 2005;17:170-3.
9. Martin CR, Walker WA. Intestinal immune defenses and the inflammatory response in necrotizing enterocolitis. Sem Fetal Neonatal Med. 2006;11:e369-77.
10. Neu J. The "myth" of asphyxia and hypoxia-ischemia as primary causes of necrotizing enterocolitis. Biol Neonate. 2005;87:97-8
11. Lin PW, Narsr TR, Stoll BS. Necrotizing enterocolitis: Recent scientific advances in pathophysiology and prevention. Semin Perinatol. 2008:32;70-82.
12. Spritzer R, Koolen AM, Baerts W, Fetter WP, Lafeber HN, Sauer PJ. A prolonged decline in the incidence of necrotizing enterocolitis after the introduction of a cautions feeding regimen. Acta Paediatr Scand. 1988;77:909-11.
13. Brown EG, Sweet AY. Preventing necrotizing enterocolitis in neonates. JAMA. 1978;240:2452-4.
14. Berseth CL. Effect of early feeding on maturation of the preterm infant's small intestine. J Pediatr. 1992;120:947-53.
15. Berseth CL, Nordyke C. Enteral nutrients promote postnatal maturation of intestinal motor activity in preterm infants. Am J Physiol. 1993;264:G1046-51.
16. McClure RJ, Newell SJ. Randomized controlled study of clinical outcome following trophic feeding. Arch Dis Child Fetal Neonatal Ed. 2000;82:F29-33.
17. Tyson JE, Kennedy KA. Minimal enteral nutrition in parenterally fed neonates. Cochrane Database Syst Rev. 2000;(2):CD000504. Update in: Cochrane Database Syst Rev. 2005;(3):CD000504.
18. Kennedy KA, Tyson JE, Chamnanvanakij S. Rapid versus slow rate of advancement of feedings for promoting growth and preventing necrotizing enterocolitis in parenterally fed low-birth-weight infants. Cochrane Database Syst Rev. 2000;(2):CD001241. Update in: Cochrane Database Syst Rev. 2008;(2):CD001241.
19. Book LS, Herbst JJ, Jung AL. Comparison of fast and slow feeding rate schedules to the development of necrotizing enterocolitis. J Pediatr. 1976;89:463-6.
20. Rayyis SF, Ambalavanan N, Wright L, Carlo WA. Randomized trial of "slow" versus "fast" feed advancements on the incidence of necrotizing enterocolitis in very low birth weight infants. J Pediatr. 1999;34:293-7.
21. Walsh MC, Kliegman RM. Necrotizing enterocolitis: Treatment based on staging criteria. Pediatr Clin North Am. 1986;33:179-201.
22. LaGamma EF, Ostertag SG, Birenbaum H. Failure of delayed oral feedings to prevent necrotizing enterocolitis. Results of study in very-low-birth-weight neonates. Am J Dis Child. 1985;139:385-9.
23. Okada Y, Klein N, Pierro A. Small volumes of enteral feedings normalize immune function in infants receiving parenteral nutrition. J Pediatr Surg. 1998;33:16-9.
24. Book LS, Herbsf JJ, Jung AL. Comparison of fast and slow feeding rate schedules to the development of necrotizing enterocolitis. J Pediatr. 1976;89:463-6.
25. Caple J, Armentrout D, Huseby V, Halbardier B, García J, Sparks JW, et al. Randomized controlled trial of slow versus rapid feeding volume advancement in preterm infants. J Pediatr. 2004;114:1597-600.
26. Henderson G, Craig S, Brocklehurst P, McGuire W. Enteral feeding regimens and necrotizing enterocolitis in preterm infants: Multicentre case-control study. Arch Dis Child Fetal Neonatal Ed. 2007;94:120-3.
27. Patole SK, de Klerk N. Impact of standardized feeding regimens on incidence of neonatal necrotizing enterocolitis: A systematic review and meta-analysis of observational studies. Arch Dis Child Fetal Neonatal Ed. 2005;90:F147-51.
28. Henderson G, Craig S, Brucklehurst P, McGuire W. Enteral feeding regimens and necrotizing enterocolitis in preterm infants: A multicenter case-control study. Arch Dis Child Fetal Neonatal Ed. 2009;94:F120-3
29. Berseth CL, Bisquera JA, Pafe VU. Prolonging small feeding volumes early in life decreases the incidence of necrotizing enterocolitis in very low birth weight infants. Pediatrics. 2003;11:529-34.
How to Cite
1.
Pérez LA, Pradilla GL, Díaz G, Bayter SM. Incidence of necrotizing enterocolitis among preterm newborns with early feeding. A clinical trial. biomedica [Internet]. 2011 Jun. 30 [cited 2024 May 19];31(4):485-91. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/397
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