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Influence of Enteral Nutrition on Occurrences of Necrotizing Enterocolitis in Very-Low-Birth-Weight Infants

Kimak, Karine S.*; de Castro Antunes, Margarida M.; Braga, Taciana D.; Brandt, Katia G.; de Carvalho Lima, Marilia

Journal of Pediatric Gastroenterology and Nutrition: October 2015 - Volume 61 - Issue 4 - p 445–450
doi: 10.1097/MPG.0000000000000835
Original Articles: Gastroenterology

Objective: The aim of the present study was to investigate the influence of enteral feeding management on occurrences of necrotizing enterocolitis (NEC) in very-low-birth-weight (VLBW) infants.

Methods: This was a case-control study conducted in a sample of 1028 VLBW infants (750 to 1499 g) admitted to a neonatal intensive care unit between January 2003 and May 2008. “Cases” were infants born with VLBW and diagnosed with NEC within the first 30 days of life, and “controls” were VLBW infants who did not develop NEC during this period. Occurrences of NEC were defined using the modified Bell criteria (stage ≥2).

Results: Among the 1028 VLBW infants, 55 (5.4%) developed NEC within the first month of life. Logistic regression analysis showed that breast milk given exclusively for <7 days (odds ratio [OR] = 4.02), never achieving full enteral feeding during the first month (OR = 3.50), and parenteral nutrition (OR = 2.70) were factors that increased the chances of NEC occurrence. The use of vasoactive drugs was associated with a lower risk of NEC (OR = 0.15).

Conclusions: Breast milk should be recommended as a priority for the enteral nutrition of VLBW infants for no <7 days. Enteral nutrition should start early and progress quickly to achieve full enteral feeding; these procedures may help reduce the occurrence of NEC.

*Post-Graduate Program in Child and Adolescent Health

Department of Maternal and Child Health, Federal University of Pernambuco

Neonatal Intensive Care Unit, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil.

Address correspondence and reprint requests to Margarida M. de Castro Antunes, Department of Maternal and Child Health, Federal University of Pernambuco, Endereço, Prédio das Pós-Graduações do CCS - 1o andar Cidade Universitária CEP: 50.670-420 - Recife - PE Brazil. (e-mail:

Received 17 February, 2015

Accepted 17 April, 2015

The present study is supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico - Brasil (grant number 473704/2006-4). Dr de Carvalho Lima is supported by a research grant.

The authors report no conflicts of interest.

© 2015 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,