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Abstract
Our previous work has shown that delaying feedings for >14 days in high risk neonates does not prevent NEC (AJDC, in press). To help determine the optimal time for initiating enteral feedings, infants at High Risk for NEC were prospectively selected from all admissions <1500g using a risk scoring system we developed. Of 112 VLBW admissions, 47 were Low Risk, 22 died within 24 hours, and 9 parents refused consent. Ultimately, 34 High Risk infants were entered into the study protocol and randomly assigned to be fed on Day 1 or 7 of life. Identical feeding protocols included parenteral nutrition and a scheduled progression from sterile water to 2.5% dextrose, half-strenght, and finally full-strength formula over 7 days. The incidence of NEC and subsequent hospital course were compared. Initiating enteral feedings on Day 1 did not increase the incidence of NEC, produce a clustering of cases, or induce an earlier onset of NEC. The overall incidence of NEC was 29% (5/17) and 35% (6/17) in the Day 1 and 7 groups, respectively, compared to 4.2% (2/47) in the Low Risk neonates. Only 1 infant got NEC within 3 days of feeding (Day 7 group) and no differences were seen in obstetrical complications, BW, GA, Apgars, PDA, IVH, and respiratory or oxygen requirements. Infants fed enterally from Day 1 did show a trend toward significantly higher energy and protein intakes during the second week of life. These data suggest that providing dilute, early enteral calories does not affect the incidence of NEC, but may promote improved nutritional status in sick, high-risk, VLBW neonates.
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