Standardised feeding regimens: hope for reducing the risk of necrotising enterocolitis

Necrotising enterocolitis (NEC), an acquired gastrointestinal disease in neonatal intensive care unit survivors, affects one to three infants per 1000 live births and is associated with significant mortality and morbidity.^2,3 Although it has not been proven, many believe that, in premature infants, a precursor to NEC is feeding intolerance, specifically, prefeed gastric residuals or bile stained aspirates.^4–6 These associated intestinal signs of NEC may also reflect a delay in maturation of the neonate’s motor activity such that they lack complete interdigestive cycles during fasting. As no biological markers exist to diagnose NEC, clinical wisdom guides decision making related to its diagnoses and management. Furthermore, there is a paucity of research identifying feeding practices, except for breast milk feeds, that offer the greatest potential benefit against developing NEC. Moreover, hormonal, anatomical, and functional limitations of low birthweight infants, the additive effects of critical illness, and intrauterine environmental factors—for example, antenatal glucocorticoids—complicate feeding decisions in this population of infants. Consequently, there is great variability in feeding orders for low birthweight infants.

A standardised feeding regimen (SFR) is one strategy to address the challenges of feeding low birthweight infants. Establishing such an SFR would require synthesising the available evidence⁷ and communicating the clinical wisdom from the experts, thereby promoting a more systematic approach to feeding low birthweight infants. A systematic review …