Prevention of necrotizing enterocolitis in preterm infants: a 20-year experience.
OBJECTIVE
Diet, indomethacin, and early use of dexamethasone have been implicated as possible causes of necrotizing enterocolitis and intestinal perforation. Because we seldom prescribe indomethacin or early dexamethasone therapy and we follow a special dietary regimen that provides late-onset, slow, continuous drip enteral feeding, we reviewed our 20 years of experience for the incidence of necrotizing enterocolitis and bowel perforation.


METHODS
We reviewed data on all 1239 very low birth weight infants (501-1500 g) admitted to our level III unit over a period of 20 years (1986-2005), for morphologic parameters, necrotizing enterocolitis, bowel perforation, use of the late-onset, slow, continuous drip protocol, and indomethacin therapy. Outcome data were also compared with Vermont Oxford Network data for the last 4 years.


RESULTS
In 20 years, 1158 infants received the late-onset, slow, continuous drip feeding protocol (group I), whereas 81 infants had either a change in dietary regimen, use of indomethacin, or early use of dexamethasone (group II). The rate of necrotizing enterocolitis in group I of 0.4% was significantly lower than that in group II of 6%. Group I, in comparison with the Vermont Oxford Network, had significantly lower rates of necrotizing enterocolitis (0.4% vs 5.9%), surgical necrotizing enterocolitis (0.4% vs 3.1%), and bowel perforation (0.35% vs 2.2%).


CONCLUSIONS
Our 20-year experience with 1239 very low birth weight infants suggests strongly that the late-onset, slow, continuous drip feeding protocol and avoidance of indomethacin and early dexamethasone treatment contribute to the prevention of necrotizing enterocolitis.
Pietz
Jeff
J
Neonatal Division, Department of Pediatrics, Fairview Hospital, Cleveland Clinic Health System, Cleveland, Ohio 44111-5656, USA. jeff_pietz@pediatrix.com
Achanti
Babu
B
Lilien
Lawrence
L
Stepka
Erin Clifford
EC
Mehta
Sudhir Ken
SK
D003907:Dexamethasone / Q000009:adverse effects / Q000627:therapeutic use; D020345:Enterocolitis, Necrotizing / Q000209:etiology / Q000517:prevention & control*; D005248:Feeding Methods; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000009:adverse effects / Q000627:therapeutic use; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000209:etiology / Q000517:prevention & control*; D019102:Infant, Very Low Birth Weight; D007416:Intestinal Perforation / Q000209:etiology / Q000517:prevention & control; D008297:Male
D003907:Dexamethasone; D007213:Indomethacin