- Influence of feeding on the severity of necrotizing enterocolitis in preterm infants
Influence of feeding on the severity of necrotizing enterocolitis in preterm infants
SOVREMENNAYA PEDIATRIYA.2018.3(91):33-37; doi 10.15574/SP.2018.91.33
Rusak N. P.
National Pirogov Memorial Medical University, Vinnytsia, Ukraine
Objective: to study the influence of the feeding pattern of premature infants with necrotic enterocolitis (NEC) of varying severity on the further course of the disease.
Material and methods. In total 67 premature infants were under observation, who were divided into 3 groups: group I consisted of 20 children with NEC I stage, group II — 30 children with NEC II stage, group III — 7 children with NEC III stage. The control group comprised 10 preterm infants without NEC. Statistical processing of the results was carried out using the software package Statistica 6.1. The difference in parameters was considered statistically significant with p<0.05.
Results. The children of groups III and II started enteral nutrition later — at the age of 3.6±0.7 and 2.9±0.4 days of life, than the children of group ІІ — on 1.4±0.1 day of life and the children from the control group — at the age of 1.2±0.1 day (р<0.01). In early neonatal period, there were breastfed 4.2 times less children of group ІІІ, than of the control group — 1 (14.3%) and 6 (60.0%) children, respectively (p<0.05). The children from group III were longer on an enteral nutrition through an orogastric probe compared to children of other groups — 59.1±4.9 days (p<0.01). After the first clinical symptoms onset of NEC, the duration of total parenteral nutrition was significantly higher in the children of group III — 9.9±1.9 days (р<0.01). After restoring tolerance to enteral nutrition, the children from the main groups were restarted the enteral feeding and administered partial parenteral nutrition. The duration of partial parenteral nutrition in the children of group I was significantly shorter than those of group II — 26.8±3.9 and 34.8±4.8 days, respectively (р<0.05), and the children of group III — 52.9±4.3 days (р<0.01).
Conclusions. The severe course of NEC is associated with later initiated enteral nutrition — at the age of 3.6±0.7 days (р<0.01), the lack of breastfeeding in 6 (85.7%) children (р<0.05) and, as a consequence, a long stay on enteral feeding through the orogastric probe — 59.1±4.9 days, the prolongation of the total parenteral nutrition — 9.9±1.9 days and partial parenteral nutrition — 52.9±4.3 days (р<0.01).
Key words: necrotic enterocolitis, premature infants, feeding.
1. Dobryanskyу DO. (2011). Enterial nutrition of premature infants with very low body weight at birth: modern priorities. Health of the child. 7(34): 121-128.
2. Mavropolo TK, Makedonsky IO. (2014). Necrotic enterocolitis of newborns (based on the principles of evidence-based medicine). Neonatology, surgery and perinatal medicine. ІV; 3(13): 116-126.
3. Minaev SV, Kyrgizov IV, Obedin AN et al. (2013). Monitoring of the development of inflammatory complications in newborns with congenital pathology of the gastrointestinal tract. Medical Herald of the North Caucasus. 8; 2: 30-33.
4. Unified clinical protocol of secondary (specialized) and tertiary (highly specialized) medical care "Enteral nutrition of preterm infants". (2017). http://www.moz.gov.ua.
5. Agostoni C, Buonocore G, Carnielli VP, De Curtis M, Darmaun D, Decsi T et al. (2010). Enteral nutrient supply for preterm infants: commentary from the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition Committee on Nutrition. JPGN. 50(1): 85-91.
6. Butte M, Lindner U, Sauer H, Schondorf D, Gortner L et al. (2014). Conservative Enteral Feeding Policy and Necrotizing Enterocolitis (NEC) in VLBW Infants: A Single Center Experience. J Pediatr Neonatal Care. 1(1): 00002.
7. Downard CD, Renaud E, Peter SDSt, Abdullah F, Islam S, Saito JM, Blakely ML, Huang EY, Arca M, Cassidy L, Aspelund G. (2012, Nov). Treatment of necrotizing enterocolitis: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review. Journal of Pediatric Surgery. 47(11): 2111-2122.
8. Henry MC, Moss RL. (2009). Necrotizing enterocolitis. Annual Review of Medicine. 60: 11-24.
9. Lambert DK, Christensen RD, Baer VL, Henry E, Gordon PV, Besner GE, Wilkes J, Wiedmeier SE, Gerday E. (2012). Fulminant necrotizing enterocolitis in a multihospital healthcare system. J Perinatol. 32(3): 194.
10. Latal-Hajnal В, Siebenthal K, Kovari H et al. (2003). Postnatal growth in VLBW infants: significant association with neurodevelopmental outcome. J Pediatr. 143: 163-170.
11. Maheshwari A, Corbin L, Schelonka RL. (2011). Neonatal necrotizing enterocolitis. Research and Reports in Neonatology. 1: 39-53.
12. Merhar SL, Ramos Y, Meinzen–Derr J, Kline-Fath BM. (2014). Brain magnetic resonance imaging in infants with surgical necrotizing enterocolitis or spontaneous intestinal perforation versus medical necrotizing enterocolitis. J Pediatr.164(2): 410-412.
13. Necrotizing Enterocolitis (NEC) Guideline Team, Cincinnati Children's Hospital Medical Center: Evidence-based care guideline for Necrotizing Enterocolitis among very low birth weight infants. Pediatric Evidence-Based Care Guidelines, Cincinnati Children's Hospital Medical Center Guideline 28, pages 1-10, October, 2010.
14. Patel BK, Shah JS. (2012). Gastroenterology. Necrotizing Enterocolitis in Very Low Birth Weight Infants: A Systemic Review. ISRN Gastroenterol. 2012: 562594. Published online Sep 10, 2012.
15. Radmacher PG, Adamkin DH. Radmacher PG. (2017). Fortification of Human milk for preterm infants. Seminars in Fetal and Neonetal Medicine.22(1): 30-5.
16. Sharma RА, Hudak ML. (2013). A clinical perspective of necrotizing enterocolitis: past, present, and future. Clin Perinatol. 40: 27–51.
17. Sullivan S et al. (2010). An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products. Journal of Pediatrics.156(4): 562-7.