Impact of standardised feeding regimens on incidence of neonatal necrotising enterocolitis: a systematic review and meta-analysis of observational studies.
BACKGROUND
A significant and prolonged decline in the incidence of necrotising enterocolitis (NEC), nearing virtual elimination in some centres, has been observed consistently since implementation of a standardised feeding regimen.


OBJECTIVE
To systematically review the observational studies reporting incidence of NEC in preterm, low birth weight (LBW) neonates "before" and "after" implementation of a standardised feeding regimen.


METHODS
The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2002), Medline, Embase, Cinahl, and proceedings of the Pediatric Academic Societies (published in Pediatric Research from 1980) were searched in July and again in October 2003. The reference lists of identified observational studies, and personal files, were searched. No language restriction was applied. Key words were: standardised, enteral, feeding, neonates, necrotising enterocolitis. Authors were contacted for clarification of data.


RESULTS
Six eligible studies (1978-2003) were identified. A significant heterogeneity was noted between the studies indicating the variations in the population characteristics and feeding practices over a period of 25 years. Meta-analysis of the six studies using a random effects model revealed a pooled risk ratio of 0.13 (95% confidence interval 0.03 to 0.50)-that is, introduction of a standardised feeding regimen reduced the incidence of NEC by 87%.


CONCLUSIONS
Standardised feeding regimens may provide the single most important global tool to prevent/minimise NEC in preterm neonates. Randomised controlled trials are needed.
Patole
S K
SK
Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, University of Western Australia, Perth, Western Australia 6008. skpatole@hotmail.com
de Klerk
N
N
D020345:Enterocolitis, Necrotizing / Q000453:epidemiology / Q000517:prevention & control*; D005248:Feeding Methods; D006801:Humans; D041943:Infant Formula; D007227:Infant Nutritional Physiological Phenomena; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000517:prevention & control*; D019102:Infant, Very Low Birth Weight; D007441:Intubation, Gastrointestinal / Q000379:methods; D008895:Milk, Human; D012307:Risk Factors
Pediatrics. 2000 Feb;105(2):379-84
10654959
Pediatr Res. 1998 Oct;44(4):519-23
9773840
J Nutr. 2000 Feb;130(2S Suppl):426S-431S
10721920
JAMA. 2000 Apr 19;283(15):2008-12
10789670
Int J Clin Pract. 2000 Sep;54(7):429-31
11070566
Int J Clin Pract. 2000 Oct;54(8):504-8
11198727
Adv Nutr Res. 2001;10:39-65
11795053
Adv Nutr Res. 2001;10:123-37
11795037
Adv Exp Med Biol. 2002;503:83-90
12026031
J Hum Lact. 2002 May;18(2):172-7
12033080
Rev Hosp Clin Fac Med Sao Paulo. 2002 Sep-Oct;57(5):243-8
12436182
Paediatr Perinat Epidemiol. 2002 Oct;16(4):342-9
12445151
Arch Pediatr Adolesc Med. 2003 Jan;157(1):66-71
12517197
Pediatrics. 2003 Apr;111(4 Pt 2):e461-70
12671166
Pediatrics. 2003 Apr;111(4 Pt 2):e519-33
12671172
Adv Neonatal Care. 2002 Feb;2(1):27-36
12903233
Med Hypotheses. 2003 Nov-Dec;61(5-6):617-22
14592797
Ann Surg. 1978 Jan;187(1):1-7
413500
JAMA. 1978 Nov 24;240(22):2452-4
101680
Pediatr Clin North Am. 1986 Feb;33(1):179-201
3081865
Acta Paediatr Scand. 1988 Nov;77(6):909-11
3144829
J Pediatr. 1990 Jul;117(1 Pt 1):132-8
2196355
J Pediatr. 1991 Oct;119(4):630-8
1919897
Acta Paediatr Suppl. 1994;396:2-7
8086675
Pediatrics. 1997 Jan;99(1):100-14
8989346