title: [Reduction in necrotising enterocolitis after implementing an evidence-based enteral nutrition protocol in very low birth weight newborns].
abstract: BACKGROUND
  An unexpected increase in the incidence of necrotising enterocolitis (NEC) cases was observed in our hospital. Just in case, our feeding policy could be responsible, it was decided to conduct a systematic review and develop a clinical guideline regarding enteral nutrition of very low birth weight infants (VLBW).
  
  
  OBJECTIVE
  To assess the impact of the new feeding protocol in the incidence of NEC.
  
  
  METHODS
  A "before" (2011) and "after" (May 2012 - April 2013) study was performed on the new feeding protocol. This included initiation of enteral feeding in the absence of haemodynamic problems, a trophic feeding period of 5-7 days, and subsequent increments of 20-30ml/kg/day, of breast milk/donor human milk from the beginning. Probiotics were not administered.
  
  
  METHODS
  incidence of NEC II 2 Bell's stage.
  
  
  RESULTS
  focal intestinal perforation, overall mortality and mortality due to NEC, nosocomial sepsis; weight at 28 days and 36 weeks; % of infants with weight <p10 at discharge; and length of stay.
  
  
  RESULTS
  Of the 270 VLBW infants, 155 were included in the "before" group, and 115 in the "after" group. NEC significantly decreased (12/155 vs 1/115, P=.008). A decrease in mortality rate was also observed (17.4% vs 7.8%, P=.02). In four cases NEC was part of the sequence of events that led to death in the first cohort, with none in the second. There was no difference in the incidence of focal intestinal perforation or of the other secondary variables analysed.
  
  
  CONCLUSIONS
  Implementation of an evidence-based enteral feeding protocol leads to a decrease in incidence of NEC, without increasing hospital stay or the incidence of sepsis.
authors.affiliation: Grupo multidisciplinario de investigación pediátrica, Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga. Facultad de Medicina, Universidad de Málaga, Málaga, España. Electronic address: tomas.sanchez.tamayo@gmail.com.
authors.forename: Tomás
authors.initials: T
authors.lastname: Sánchez-Tamayo
authors.affiliation: Grupo multidisciplinario de investigación pediátrica, Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga. Facultad de Medicina, Universidad de Málaga, Málaga, España.
authors.forename: María Gracia
authors.initials: MG
authors.lastname: Espinosa Fernández
authors.affiliation: Grupo multidisciplinario de investigación pediátrica, Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga. Facultad de Medicina, Universidad de Málaga, Málaga, España.
authors.forename: Laura
authors.initials: L
authors.lastname: Affumicato
authors.affiliation: Grupo multidisciplinario de investigación pediátrica, Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga. Facultad de Medicina, Universidad de Málaga, Málaga, España.
authors.forename: María
authors.initials: M
authors.lastname: González López
authors.affiliation: Grupo multidisciplinario de investigación pediátrica, Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga. Facultad de Medicina, Universidad de Málaga, Málaga, España.
authors.forename: Verónica
authors.initials: V
authors.lastname: Fernández Romero
authors.affiliation: Grupo multidisciplinario de investigación pediátrica, Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga. Facultad de Medicina, Universidad de Málaga, Málaga, España.
authors.forename: María Concepción
authors.initials: MC
authors.lastname: Moreno Algarra
authors.affiliation: Grupo multidisciplinario de investigación pediátrica, Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga. Facultad de Medicina, Universidad de Málaga, Málaga, España.
authors.forename: Enrique
authors.initials: E
authors.lastname: Salguero García
mesh_terms: D002985:Clinical Protocols; D004750:Enteral Nutrition; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology* / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D017410:Practice Guidelines as Topic; D011446:Prospective Studies
keywords: Alimentación enteral; Bowel perforation; Enteral nutrition; Enterocolitis necrosante; Guía de práctica clínica; Necrotising enterocolitis; Nutrición enteral trófica; Perforación intestinal focal; Practice guideline; Premature infant; Prematuro; Prevención; Prevention; Recién nacido de muy bajo peso; Trophic feeding; Very low birth weight infant