Enteral feeding regimens and necrotising enterocolitis in preterm infants: a multicentre case-control study

Abstract

Background: Most preterm infants who develop necrotising enterocolitis (NEC) have received enteral feeds. Uncertainty exists about which aspects of the feeding regimen affect the risk of NEC. Aim: To examine associations between enteral feeding practices and the development NEC in preterm infants. Methods: Multi-centre case-control study. 53 preterm infants with NEC were enrolled together with gestational-age frequency-matched control infants without NEC from a randomly selected neonatal unit. Clinical and feeding data were extracted and compared between the groups. Results: Significantly fewer cases than controls had received human breast milk [75% versus 91%: odds ratio= 0.32 (95% confidence interval (CI) 0.11 to 0.98)]. The day after birth on which enteral feeding was commenced did not differ significantly: mean cases 2.9 (standard deviation [SD] 2.8); controls 2.8 (SD 1.8). The mean duration of trophic feeding (<1mL/kg/h) was significantly shorter in the cases [3.3 (SD 3.1) days] than controls [6.2 (SD 6.7) days]: mean difference [MD] 2.9 (95% CI 4.9 to 0.9) days. Cases were fully fed significantly earlier than controls [cases 9.9 (SD 4.2); controls 14.3 (SD 9.8): MD 4.4 (95% CI 7.3 to 1.5) days after birth]. Conclusions: This study found that the duration of trophic feeding and rate of advancement of feed volumes was associated with the risk of NEC in preterm infants. Further randomised controlled trials that assess the effect of different rates of feed advancement on the incidence of NEC, as well as other outcomes, are warranted.