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Timing of nutritional exposures in relation to the development of severe necrotising enterocolitis (NEC) in preterm growth restricted infants

Presented at the Neonatal Society 2018 Spring Meeting (programme).

Juszczak E, Partlett C, Leaf A, Linsell L, Hall N

National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford
University Surgery Unit, Faculty of Medicine, University of Southampton

Background: Despite a recognised association between reduced NEC incidence and breast milk feeding, incidence remains high. A dependence on non-breast milk feed products due to nutritional inadequacy of an exclusive breast milk diet may contribute. We investigated the association between feed type exposure and timing, and severe (Bell stage II or III) NEC in high risk infants previously recruited to ADEPT (1).

Methods: Secondary analysis of daily feed logs. NEC cases were individually matched (gender, gestational age, birthweight) to 4 controls who had not developed NEC by the same age. Relationship between exposure to nonbreast milk feed (at <14 days of age, <28 days of age and any) and subsequent NEC was investigated using conditional logistic regression analysis adjusted for ADEPT treatment arm. Similar analyses investigated relationships between feed type exposure and late onset sepsis (LOS), and death. Funding: Action Medical Research Project Grant GN2506.

Results: Data for 399 of 404 infants randomised in ADEPT were available for inclusion. Non-significant trends towards increased incidence of severe NEC were identified in infants exposed to non-breast milk feeds in all three time periods investigated (Figure). Exposure to non-breast milk feed across all time points investigated was associated with a lower incidence of LOS which reached statistical significance (OR 0.57, [95%CI 0.35, 0.91]; p=0.02) in infants exposed ≤ 28 days. There was no evidence of an association between feed type and death.

Conclusion: Data support the hypothesis that exposure to non-breast milk feed is potentially associated with increased NEC risk in preterm infants. We believe the association between non-breast milk feed exposure and reduced LOS incidence is novel. Conclusions are limited by small sample size; findings require validation in larger datasets.

Corresponding author:

1. Early or delayed enteral feeding for preterm growth-restricted infants: a randomized trial. Leaf A, Dorling J, Kempley S, et al. Pediatrics 2012; 129:e1260-8

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