title: Early enteral feeding and nosocomial sepsis in very low birthweight infants Continuous feeding promotes gastrointestinal tolerance and growth in very low birth weight infants. Breast milk and neonatal necrotising enterocolitis National Institute of Child Health and Human Development The significance of gastric residuals in the early enteral feeding advancement of extremely low birth weight infants. Predischarge morbidities in extremely and very low-birth-weight infants in Spanish neonatal units.
abstract: 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 r and omised controlled trial OBJECTIVE To compare the effects of continuous versus intermittent feeding on gastrointestinal tolerance and growth in very low birth weight ( VLBW ) infants . STUDY DESIGN In a r and omized , controlled trial conducted at 3 neonatal units , 70 premature infants with a gestational age 24 to 29 weeks and birth weight < 1200 g were assigned to 1 of 3 feeding methods : continuous nasogastric feeding , intermittent nasogastric feeding , or intermittent orogastric feeding . Feeding was initiated within 30 hours of birth . Daily enteral and parenteral volumes , caloric and protein intakes , growth , enteral intolerance , and clinical complications were recorded . Cox regression analysis was used to determine primary outcome , the time to achieve full enteral feeding . RESULTS The continuously fed infants achieved full enteral feeding significantly faster than the intermittently fed infants ( hazard ratio [ HR ] = 1.86 ; 95 % confidence interval [ CI ] = 1.07 to 3.22 ) . In stratified analysis according to birth weight , the improvement was even more pronounced in the smallest infants , those with birth weight < or = 850 g ( adjusted HR = 4.13 ; 95 % CI = 1.48 to 11.53 ) . Growth rate was significantly faster in the continuously fed infants ( P = .002 ) . CONCLUSION In VLBW infants , continuous feeding seems to be better than intermittent feeding with regard to gastrointestinal tolerance and growth In a prospect i ve multicentre study on 926 preterm infants formally assigned to their early diet , necrotising enterocolitis developed in 51 ( 5.5 % ) .  Mortality was 26 % in stringently confirmed cases . In exclusively  formula-fed  babies confirmed disease was 6 - 10 times more common than in those fed breast milk alone and 3 times more common than in those who received formula plus breast milk . Pasteurised donor milk seemed to be as protective as raw maternal milk . Among babies born at more than 30 weeks ' gestation confirmed necrotising enterocolitis was rare in those whose diet included breast milk ; it was 20 times more common in those fed formula only . Other risk factors included very low  gestational age , respiratory disease , umbilical artery catheterisation , and polycythaemia . In formula-fed but not breast-milk-fed infants , delayed enteral feeding was associated with a lower frequency of necrotising enterocolitis . With the fall in the use of breast milk in British neonatal units , exclusive formula feeding could account for an estimated 500 extra cases of necrotising enterocolitis each year . About 100 of these infants would die The National Institute of Child Health and Human Development conducts and supports research on all stages of human development from preconception to adulthood in order to better underst and the health of children , youths , adults , families , and communities . Health and human development information is made easily available on the site with a simple A to Z list , along with clinical trials and health education campaign information . Links to clinical trials , news releases , publications , and related web sites are also available , as well as information on research being conducted at present and supported by the National Institute of Child Health and Human Development OBJECTIVE To evaluate whether the mean gastric residual volume ( GRV ) and green gastric residuals ( GR ) themselves are significant predictors of feeding intolerance in the early enteral feeding advancement in extremely low birth weight ( ELBW ; < 1000 g ) infants . DESIGN Ninety-nine ELBW infants were fed following a st and ardized protocol ( day 3 - -14 ) . At 48 hours of age , milk feeding was started ( 12 mL/kg/d increments , 12 meals per day ) . GR were checked before each feeding , and a GRV up to 2 mL/3 mL in infants less-than-or-equal750 g/>750 g was tolerated . In cases of increased GRV , feedings were reduced or withheld . The color of GR was assessed as clear , milky , green-clear , green-cloudy , blood-stained , or hemorrhagic . Multiple regression analysis was used to study the effect of the mean GRV and the color of GR on the feeding volume on day 14 ( V14 ) . RESULTS The median V14 was 103 mL/kg/d ( 0 - -166 ) . V14 increased with an increasing percentage of milky GR , whereas the mean GRV and the color green did not have a significant effect . CONCLUSIONS 1 ) Early enteral feeding could be established in ELBW infants . The critical GRV seems to be above 2 mL/3 mL because there was no significant negative correlation between the mean GRV and V14 . 2 ) Green GR were not negatively correlated with V14 and should not slow down the advancement of feeding volumes in absence of other clinical signs and symptoms We sought to describe neonatal morbidities and therapeutic interventions in very low-birth-weight ( VLBW ) and extremely low-birth-weight ( ELBW ) infants cared for in Spanish hospitals . We preformed a prospect i ve collection of data covering the perinatal period until discharge by the SEN1500 network . This network , set up by the Spanish Society of Neonatology , targets VLBW and ELBW infants ( 400 to 1500 g ) admitted to neonatal units in Spanish hospitals . Data were recorded in electronic form and controlled for possible errors or inconsistencies before analysis . We report data for 8836 neonates admitted to 48 neonatal units from January 2002 to December 2005 .  Prenatal steroids were given to significantly more newborns in 2003 to 2005 ( 79.4 % ) than in 2002 ( 73.4 % ) , although the remaining perinatal data examined failed to significantly vary . Delivery was by cesarean section in 69.8 % of cases but significantly lower ( 35.9 % ) for infants under a postmenstrual age of 26 weeks . Hyaline membrane disease was diagnosed in 53.9 % of the newborns and bronchopulmonary dysplasia ( BPD ) in 10.46 % .  Mechanical ventilation  was employed in 69.1 % , surfactant in 50.3 % , and steroids for BPD in 5.3 % . Intraventricular hemorrhage grade s 3 to 4 ( 8.1 % ) and cystic leukomalacia ( 2.6 % ) were the most relevant brain ultrasonography findings . Rates of early- and late-onset septicemia were 5 % and 29.4 % , respectively . Further diagnoses were necrotizing enterocolitis ( NEC ; 6.9 % ) and persistent ductus arteriosus ( PDA ; 24.2 % ) ; 40.6 % of the cases of NEC and 15.3 % of those of PDA required surgery . In addition , 26.6 % of the newborns required supplementary oxygen at 28 days of life . The number of newborns who had not recovered their birth weight at this age fell from 3.1 % in 2002 to 1.5 % in 2005 . Rates of prenatal steroid use , cesarean delivery , and main morbidities were comparable to figures cited for other patient series , although our BPD rate was among the lowest reported and nosocomial sepsis rate among the highest
target: The available trial data suggest that advancing enteral feed volumes at daily increments of 30 ml/kg to 35 ml/kg does not increase the risk of necrotising enterocolitis in very preterm or VLBW infants .
  Advancing the volume of enteral feeds at slow rates result ed in several days delay in regaining birth weight and establishing full enteral feeds .
  The applicability of these findings to extremely preterm , extremely low birth weight , or growth-restricted infants is limited .
background: BACKGROUND Early enteral feeding practice s are potentially modifiable risk factors for necrotising enterocolitis  in very preterm or very low birth weight ( VLBW ) infants .
  Observational studies suggest that conservative feeding regimens , including slowly advancing enteral feed volumes , reduce the risk of necrotising enterocolitis .
  However , slow feed advancement may delay establishment of full enteral feeding and be associated with metabolic and infectious morbidities secondary to prolonged exposure to parenteral nutrition .
  OBJECTIVES To determine the effect of slow rates of enteral feed advancement on the incidence of necrotising enterocolitis , mortality , and other morbidities in very preterm or VLBW infants .