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Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants

  1. Sarah Bombell2,
  2. William McGuire1,*

Editorial Group: Cochrane Neonatal Group

Published Online: 23 APR 2008

Assessed as up-to-date: 19 MAR 2009

DOI: 10.1002/14651858.CD001970.pub2


How to Cite

Bombell S, McGuire W. Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD001970. DOI: 10.1002/14651858.CD001970.pub2.

Author Information

  1. 1

    Hull York Medical School, Centre for Reviews and Dissemination, York, Y010 5DD, UK

  2. 2

    Australian National University, Centre for Newborn Care, Canberra, Australia

*William McGuire, Centre for Reviews and Dissemination, Hull York Medical School, University of York, York, Y010 5DD, UK. William.McGuire@hyms.ac.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 23 APR 2008

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This is not the most recent version of the article. View current version (31 MAY 2013)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

The introduction of progressive enteral feeds for very low birth weight infants is often delayed for several days or longer after birth due to concern that earlier introduction may not be tolerated and may increase the risk of necrotising enterocolitis. However, delaying enteral feeding could diminish the functional adaptation of the gastrointestinal tract and prolong the need for parenteral nutrition with its attendant infectious and metabolic risks.

Objectives

To determine the effect of delayed introduction of progressive enteral feeds on the incidence of necrotising enterocolitis, mortality and other morbidities in very low birth weight infants.

Search strategy

The standard search strategy of the Cochrane Neonatal Group was used. Searches were made of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2009), MEDLINE (1966 - February 2009), EMBASE (1980 - February 2009), CINAHL (1982- February 2009), conference proceedings, and previous reviews.

Selection criteria

Randomised or quasi-randomised controlled trials that assessed the effect of delayed (after 96 hours' postnatal age) versus earlier introduction of progressive enteral feeds on the incidence of necrotising enterocolitis, mortality and other morbidities in very low birth weight infants.

Data collection and analysis

The standard methods of the Cochrane Neonatal Group were used with separate evaluation of trial quality and data extraction by two review authors. Data were synthesised using a fixed effects model and reported using typical relative risk, typical risk difference and weighted mean difference.

Main results

Three small trials in which a total of 115 very low birth weight infants participated were eligible for inclusion. Only a minority of participants were of extremely low birth weight or extreme preterm gestation. These trials provided no evidence that delayed introduction of progressive enteral feeds affected the incidence of necrotising enterocolitis, mortality or other neonatal morbidities. In view of the small number of participants, important beneficial or harmful effects cannot be excluded.

Authors' conclusions

The available data are insufficient to inform clinical practice. Further large pragmatic randomised controlled trials are needed to determine how the timing of the introduction of progressive enteral feeds affects important clinical outcomes in very low birth weight infants and particularly in extremely low birth weight or growth restricted infants.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants

There is insufficient evidence to determine whether delaying the introduction of enteral milk feeds given to very low birth weight infants reduces the incidence of necrotising enterocolitis.

Very low birth weight infants (birth weight less than 1500 grams) are at risk of developing a severe bowel disorder called "necrotising enterocolitis". It is thought that one possible way to prevent this condition is to delay the introduction of milk feeds until several days (or longer) after birth. Only two small trials have assessed the effect of delayed rather than early introduction of milk feeds for very low birth weight infants. Data from these trials are insufficient to guide clinical practice. Further trials are needed to provide evidence to inform this key area of care.