Virtual elimination of necrotising enterocolitis for 5 years - reasons?
A standardised feeding regimen was adopted in 1997 for guiding enteral feeding of neonates <32 weeks' gestation during clinical trials (18 months each) involving erythromycin (n=73) as a prokinetic and carboxymethylcellulose (n=70) as a laxative as well as for during 2 years (n=155) without any trials. Most aspects of the feeding regimen (e.g., milk increments-total volume/day, use of breast milk by choice, etc) were not significantly different from current practices.


RESULTS
298 neonates <32 weeks' gestation (<28 weeks; n=78) were enterally fed during the 5 years. Their demographic characteristics and median (interquartile) age in days at starting (AST) and days to reach full enteral feeds (FFT) of 150 ml/kg/day were not significantly different during these 5 years: [AST: 5 (3-7.5)], [FFT: 4 (3-7)] Only one case of definite NEC (> or =Stage II) occurred during the 5 years. The time to reach full feeds was also reduced by over 54% (including for neonates <28 weeks gestation) compared with a historical cohort.


CONCLUSIONS
Sustained reduction in the time to reach full feeds with virtual elimination of > or =Stage II NEC for 5 years indicates continued benefits of a standardised feeding regimen as a simple preventive strategy to prevent NEC. Whether our specific policy of no enteral feeds in presence of hemodynamic instability associated with PDA requiring indomethacin, and/or sepsis played a role in achieving the significant results needs controlled trials.
King Edward Memorial Hospital for Women, Western Australia 6008, Subiaco, Australia. skpatole@hotmail.com
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S
Patole
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McGlone
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Muller
D002266:Carboxymethylcellulose Sodium / Q000494:pharmacology; D004750:Enteral Nutrition; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis* / Q000473:pathology*; D004917:Erythromycin / Q000494:pharmacology; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000494:pharmacology; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D008895:Milk, Human / Q000378:metabolism; D008962:Models, Theoretical; D010100:Oxygen / Q000378:metabolism; D018805:Sepsis
D004917:Erythromycin; D002266:Carboxymethylcellulose Sodium; D010100:Oxygen; D007213:Indomethacin