ORIGINAL ARTICLE

Early enteral feeding and nosocomial sepsis in very low birthweight infants

O Flidel-Rimon¹, S Friedman¹, E Lev², A Juster-Reicher¹, M Amitay¹ and E S Shinwell¹

¹ Department of Neonatology, Kaplan Medical Center, Rehovot, Israel and The Hebrew University, Jerusalem, Israel
² Department of Pediatrics, Schneider Children’s Hospital, Petach-Tiqva, Israel

Correspondence to:
Correspondence to:
Dr Shinwell
Department of Neonatology, Kaplan Medical Center, PO Box 1, Rehovot, Israel; eric_s{at}clalit.org.il

Background: The interrelations between early enteral feeding, necrotising enterocolitis (NEC), and nosocomial sepsis (NS) remain unclear.

Objective: To evaluate the effect of age at the introduction of enteral feeding on the incidence of NS and NEC in very low birthweight (VLBW< 1500 g) infants.

Methods: Data were collected on the pattern of enteral feeding and perinatal and neonatal morbidity on all VLBW infants born in one centre during 1995–2001. Enteral feeding was compared between infants with and without NS and/or NEC.

Results: The study sample included 385 infants. Of these, 163 (42%) developed NS and 35 (9%) developed NEC. Enteral feeding was started at a significantly earlier mean (SD) age in infants who did not develop nosocomial sepsis (2.8 (2.6) v 4.8 (3.7) days, p  =  0.0001). Enteral feeding was introduced at the same age in babies who did or did not develop NEC (3.1 (2) v 3.7 (3) days, p  =  0.28). Over the study period, the mean annual age at the start of enteral feeding fell consistently, and this correlated with the mean annual incidence of NS (r²  =  0.891, p  =  0.007). Multiple logistic regression analysis showed age at start of enteral feeding, respiratory distress syndrome, and birth weight to be the most significant predictors of risk of NS (p  =  0.0005, p  =  0.024, p  =  0.011).

Conclusions: Early enteral feeding was associated with a reduced risk of NS but no change in the risk of NEC in VLBW infants. These findings support the use of early enteral feeding in this high risk population, but this needs to be confirmed in a large randomised controlled trial.

Abbreviations: CRIB, clinical risk index for babies; NEC, necrotising enterocolitis; NICU, neonatal intensive care unit; RDS, respiratory distress syndrome; VLBW, very low birthweight

Keywords: enteral feeding; necrotising enterocolitis; nosocomial sepsis; preterm; very low birth weight

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Fantoms

Martin Ward Platt
Arch. Dis. Child. Fetal Neonatal Ed. 2004 89: F283. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Henderson, G, Craig, S, Brocklehurst, P, McGuire, W (2009). Enteral feeding regimens and necrotising enterocolitis in preterm infants: a multicentre case-control study. Arch. Dis. Child. Fetal Neonatal Ed. 94: F120-F123 [Abstract] [Full Text]  
• Hans, D. M., Pylipow, M., Long, J. D., Thureen, P. J., Georgieff, M. K. (2009). Nutritional Practices in the Neonatal Intensive Care Unit: Analysis of a 2006 Neonatal Nutrition Survey. Pediatrics 123: 51-57 [Abstract] [Full Text]  
• Sisk, P. M., Lovelady, C. A., Gruber, K. J., Dillard, R. G., O'Shea, T. M. (2008). Human Milk Consumption and Full Enteral Feeding Among Infants Who Weigh <=1250 Grams. Pediatrics 121: e1528-e1533 [Abstract] [Full Text]  
• Chauhan, M, Henderson, G, McGuire, W (2008). Enteral feeding for very low birth weight infants: reducing the risk of necrotising enterocolitis. Arch. Dis. Child. Fetal Neonatal Ed. 93: F162-F166 [Abstract] [Full Text]  
• Sisk, P. M., Lovelady, C. A., Dillard, R. G., Gruber, K. J. (2006). Lactation Counseling for Mothers of Very Low Birth Weight Infants: Effect on Maternal Anxiety and Infant Intake of Human Milk. Pediatrics 117: e67-e75 [Abstract] [Full Text]  
• desRobert, C., Lane, R., Li, N., Neu, J. (2005). Neonatal Nutrition and Consequences on Adult Health. NeoReviews 6: e211-e219 [Full Text]