Virtual elimination of necrotising enterocolitis for 5 years: reasons?

Abstract

A standardised feeding regimen was adopted in 1997 for guiding enteral feeding of neonates <32 weeks’ gestation during clinical trials (18 months each) involving erythromycin (n=73) as a prokinetic and carboxymethylcellulose (n=70) as a laxative as well as for during 2 years (n=155) without any trials. Most aspects of the feeding regimen (e.g., milk increments-total volume/day, use of breast milk by choice, etc) were not significantly different from current practices. Results. 298 neonates <32 weeks’ gestation (<28 weeks; n=78) were enterally fed during the 5 years. Their demographic characteristics and median (interquartile) age in days at starting (AST) and days to reach full enteral feeds (FFT) of 150 ml/kg/day were not significantly different during these 5 years: [AST: 5 (3–7.5)], [FFT: 4 (3–7)] Only one case of definite NEC (Stage II) occurred during the 5 years. The time to reach full feeds was also reduced by over 54% (including for neonates <28 weeks gestation) compared with a historical cohort.

Conclusion: sustained reduction in the time to reach full feeds with virtual elimination of Stage II NEC for 5 years indicates continued benefits of a standardised feeding regimen as a simple preventive strategy to prevent NEC. Whether our specific policy of no enteral feeds in presence of hemodynamic instability associated with PDA requiring indomethacin, and/or sepsis played a role in achieving the significant results needs controlled trials.