title: Prevention of necrotizing enterocolitis in preterm infants: a 20-year experience.
abstract: 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.
authors.affiliation: Neonatal Division, Department of Pediatrics, Fairview Hospital, Cleveland Clinic Health System, Cleveland, Ohio 44111-5656, USA. jeff_pietz@pediatrix.com
authors.forename: Jeff
authors.initials: J
authors.lastname: Pietz
authors.forename: Babu
authors.initials: B
authors.lastname: Achanti
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lilien
authors.forename: Erin Clifford
authors.initials: EC
authors.lastname: Stepka
authors.forename: Sudhir Ken
authors.initials: SK
authors.lastname: Mehta
mesh_terms: 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
chemical_list: D003907:Dexamethasone; D007213:Indomethacin