Стратегия энтерального питания новорожденных с некротизирующим энтероколитом

Abstract

Study objective. To optimize the recommendations on the strategy of enteral feeding for newborn babies with necrotizing enterocolitis (NEC). Patients and methods. A single-centre, observational, prospective, analytical, cohort study of 186 infants aged from 2 days to 2 months (96 boys, 90 girls) with the verified diagnosis of NEC of varied severity, who were treated at the neonatal pathology department of Moscow G.N.Speransky Children’s City Clinical Hospital No 9 in 2016-2018. The patients were divided into 2 groups, depending on disease staging according to the Walsh and Kliegman classification: group I – 124 (66.7%) newborns with mild NEC (stage 1A, B and 2A) and group II – 62 (33.3%) patients with a severe course (stages 2B and 3A, B). Results. As has been found, maternal risk factors for the development of severe forms of NEC in newborns are: maternal age over 40 years (OR = 1.40, 95% CI 0.83–2.17), assisted reproductive technologies (OR = 2.62, 95% CI 1.79–3.66), bad obstetrical-gynaecological history (OR = 1.80, 95% CI 1.03–2.97), infectious diseases during pregnancy (OR = 1.37, 95% CI 0.69–1.90). The ranking of the risk factors present in babies themselves permitted to find a causative relation with such factors as bacteriological contamination of biological media (OR = 2.80, 95% CI 1.3–4.0), bacteremia, viremia (OR = 5.80, 95% CI 2.99–7.13), gestational age 30–32 wks (OR = 2.35, 95% CI 1.01–3.94), which were significant only for mild forms of NEC. A minimal number of severe cases was diagnosed for a combination of breastfeeding and parenteral nutrition (16.7%), development of severe NEC was more often noted when feeding was started within 5 days: breastfeeding (26.3%), formula feeding (33.3 %), mixed breast and formula feeding (5%), or in infants who did not receive feeding due to their severe condition after birth (33%) (р < 0.05). The minimal number of severe NEC cases was found among babies who remained on breast (11.1%) and mixed (11.1%) feeding after the 5th day (р < 0.05), the maximal number – in infants who started from enteral feeding and were transferred to formula feeding (50%). Prolonged enteral feeding was three times more often associated with a severe course of NEC (р < 0.001). Conclusion. As has been found, the frequency of developing severe NEC depends on the character of the first feed after birth. A risk of developing severe forms of NEC decreases in newborns on breast- or mixed feeding, in combination of breast feeding and parenteral nutrition, short courses of enteral pauses, alternation of enteral feeding and enteral pauses. The results might be used in the clinical practice of neonatologists and paediatricians for prevention and management of NEC and its possible complications in newborn infants. Key words: necrotising enterocolitis, enteral pause, enteral nutrition, neonatology, birth weight, gestational age, premature infants