title: Nil-per-os days and necrotizing enterocolitis in extremely preterm infants.
abstract: OBJECTIVE
  This study aims to evaluate the association between nil-per-os (NPO) days and development of necrotizing enterocolitis (NEC) in extremely preterm neonates (<29 weeks gestational age).
  
  
  METHODS
  A case-control study of 234 extremely preterm neonates who developed stage II or III NEC and 467 matched control infants admitted to participating sites in the Canadian Neonatal Network between 2010 and 2011 was conducted. The number and percentage of NPO days before the development of NEC was compared with the equivalent period in control infants using logistic regression.
  
  
  RESULTS
  Infants with NEC were NPO on average 5.6 days (28% of days before NEC) versus 3.7 days (19% of equivalent days; p < 0.01) among controls. NEC cases required more days of inotropic support, antibiotic use, and had higher rates of patent ductus arteriosus (PDA). After adjusting for inotrope use, PDA, antibiotics, and severity of illness, for each additional NPO day the adjusted odds for NEC increased by 1.08 (95% confidence interval: 1.04-1.12).
  
  
  CONCLUSIONS
  Among extremely preterm neonates, those who developed NEC were NPO for a longer period of time than control infants who were NEC-free. We speculate that delayed initiation or interruption of feeding may be a potent risk factor for NEC.
authors.affiliation: Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Maksim
authors.initials: M
authors.lastname: Kirtsman
authors.affiliation: Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Eugene W
authors.initials: EW
authors.lastname: Yoon
authors.affiliation: Department of Pediatrics, Saint John Regional Hospital, Saint John, New Brunswick, Canada.
authors.forename: Cecil
authors.initials: C
authors.lastname: Ojah
authors.affiliation: Department of Pediatrics, Royal Columbian Hospital, New Westminster, British Columbia, Canada.
authors.forename: Zenon
authors.initials: Z
authors.lastname: Cieslak
authors.affiliation: Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Shoo K
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Prakesh S
authors.initials: PS
authors.lastname: Shah
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D002170:Canada; D016022:Case-Control Studies; D004374:Ductus Arteriosus, Patent / Q000188:drug therapy*; D020345:Enterocolitis, Necrotizing / Q000188:drug therapy*; D005215:Fasting / Q000009:adverse effects*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use*; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D016015:Logistic Models; D008297:Male; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007213:Indomethacin