gms | German Medical Science

Background: Recently, the A.S.P.E.N. Clinical Guidelines on nutritional support of neonatal patients at risk for necrotising enterocolitis (NEC) were published [1] proposing a regimen of advancing enteral feeds by 30 mLs/kg/d. Of note currently reported prevalence rates of NEC by large neonatal networks from the US range around 7% [2].

Study purpose: To assess the rate of NEC and important growth parameters in a high-risk patient cohort (VLBW infants: < 1500 grams, and ELBW < 1000 grams) that were subjected to a “conservative” feeding regimen.

Methods: Preliminary data from a retrospective analysis at a tertiary University hospital NICU with an approximate annual admission of VLBW infants around 50-60.

Results: 38 infants were consecutively included with a mean GA of 27+3 weeks (range: 24+3-33+5 weeks). Mean birth weight was 869.6±162.9 grams (10-25^th percentile; range: 570-1240 grams; head circumference: 24.5 cm = 10-25^th percentile). The median daily increase in feeds was 8.4 g/kg/day. Birth weight was regained after a median of 11.5 days; infants were on full feeds after a median of 22 days (range: 14 - 37 days with a median weight of 1060 grams (3-10^th percentile); head circumference was 26 cm when on full feeds (3-10^th percentile). Infants were discharged or transferred to a different unit after a median of 86 days (median weight at discharge 2607.5 grams < 3^rd percentile; head circumference: 33.3cm = 3-10^th percentile). No differences were seen between ELBW infants and VLBW infants and non-IUGR and IUGR infants. Two clinical episodes occurred in 2 infants that were suggestive of NEC, but NEC was not confirmed.

Discussion: Our “conservative” enteral feeding regimen was associated an unusual low rate of NEC. Our data also demonstrated that a slow feeding regimen is associated with an abnormal initial growth pattern with regard to both body weight and head circumference. Given the long-term implications of both adequate enteral nutrional support and the devastating effects of NEC (i.e. a disproportionate increase in poor neurological outcome [3]) - future studies should assess long-term neurological outcome when evaluating different enteral feeding practices in this cohort.