title: Standardized Slow Enteral Feeding Protocol and the Incidence of Necrotizing Enterocolitis in Extremely Low Birth Weight Infants.
abstract: BACKGROUND
  Compared with early enteral feeds, the delayed introduction and slow advancement of enteral feedings to reduce the incidence of necrotizing enterocolitis (NEC) are not well studied in extremely low birth weight (ELBW) infants.
  
  
  OBJECTIVE
  To study the effects of a standardized slow enteral feeding (SSEF) protocol in ELBW infants.
  
  
  METHODS
  ELBW infants who followed an SSEF protocol (September 2009 to December 2012) were compared with a similar group of historical controls (January 2003 to July 2009). Short-term outcomes between the 2 groups were compared by propensity score (PS) analysis.
  
  
  RESULTS
  One hundred twenty-five infants in the SSEF group were compared with 294 historical controls. Compared with the controls, feeding initiation day, full enteral feeding day, parenteral nutrition (PN) days, and total central line days were longer in the SSEF group. There was no significant difference in overall NEC (5.6% vs 11.2%, respectively; P = .10) or surgical NEC (1.6% vs 4.8%, respectively; P = .17) between the SSEF group and controls. However, in infants with birth weight <750 g, NEC (2.1% vs 16.2%, respectively; P < .01) or combined NEC/death (12.8% vs 29.5%, respectively; P = .03) was significantly less in the SSEF group compared with controls. In infants who survived to discharge, there was no significant difference in the discharge weight or length of stay in PS-adjusted analysis.
  
  
  CONCLUSIONS
  An SSEF protocol significantly reduces the incidence of NEC and combined NEC/death in infants with birth weight <750 g. Despite taking longer to achieve full enteral feeding on this protocol, surviving ELBW infants demonstrated comparable weight gain at discharge without prolonging their hospital stay.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio sreekanth.viswanathan@uhhospitals.org.
authors.forename: Sreekanth
authors.initials: S
authors.lastname: Viswanathan
authors.affiliation: Division of Neonatology, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Kera
authors.initials: K
authors.lastname: McNelis
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Dennis
authors.initials: D
authors.lastname: Super
authors.affiliation: Department of Epidemiology and Biostatistics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Douglas
authors.initials: D
authors.lastname: Einstadter
authors.affiliation: Division of Neonatology, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Sharon
authors.initials: S
authors.lastname: Groh-Wargo
authors.affiliation: Division of Neonatology, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Marc
authors.initials: M
authors.lastname: Collin
mesh_terms: D001724:Birth Weight; D004750:Enteral Nutrition / Q000379:methods / Q000592:standards*; D020345:Enterocolitis, Necrotizing / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D052577:Infant, Extremely Low Birth Weight / Q000254:growth & development*; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000628:therapy; D007902:Length of Stay; D008297:Male; D010288:Parenteral Nutrition / Q000379:methods / Q000592:standards; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D015430:Weight Gain
keywords: extremely low birth weight infants; feeding protocol; necrotizing enterocolitis; preterm infants