EARLY FEEDING OF VERY LOW BIRTHWEIGHT(VLBW) INFANTS INCREASES THE RISK FOR NECROTIZING ENTEROCOLITIS (NEC). 1397

Abstract

NEC is a potentially fatal gastrointestinal disease that predominantly affects LBW infants. With the increasing survival of VLBW infants, it is important to characterize this disease in this population. The aim of this study was to identify antenatal and postnatal risk factors and clinical indices that may be useful for the early diagnosis or prevention of NEC. METHOD This retrospective case-controlled study included inborn infants diagnosed with NEC at the Ottawa General Hospital. Infants were excluded if they had a confirmed or suspected genetic syndrome. The control patients (CON) were matched on the basis of gestational age (GA), birth weight (Bwt), date of admission, sex, and major diagnoses. In order to reflect current and consistent neonatal care practises, the study period of Jan.1, 1992 to Dec. 31, 1994 was chosen. RESULTS The overall incidence of NEC was 2.8/1,000 NICU admissions which varied by Bwt, with the highest incidence (82.4/1000) for Bwt 751-1000 g. 80% of NEC cases occurred in infants < 1500 g Bwt. The mean Bwt was 1221 ± 746 (SD) g (range: 438-3130 g) and GA was 28.3 ± 3.4 wk (24.0-36.3). The male to female ratio was 7:5. The average age of onset of NEC was 12.8 ± 10.9 d (range: 1-42). Compared to the CON group, the NEC group did not experience more antenatal complications. The use of antenatal steroids was not different in either group. The 1 and 5 min Apgar scores, duration of UAC and UVC lines, PDA, and indomethacin treatment were not different. 92% of infants received enteral feeds prior to the development of NEC. Initiation of enteral feeds was earlier in the NEC group and reached significance for Bwt 751-1000 g (4.4 ± 1.5 d vs 10.3 ± 3.7 d)(P<0.05). At the onset of NEC, 63% had gastric aspirates of 2.9 ± 1.3 ml which consisted of bile (20%), coffee grounds (13%) and blood (13%) and stools were positive for occult blood (33%) and frank blood (25%).. Abdominal girth increased BY 5.6 ± 5.2 cm (range: 0.1 - 10 cm) in 75% of the NEC group. Our results suggest that the best predictors for the development of NEC are prematurity and LBW. Early enteral feeding appears to significantly increase the risk for NEC in VLBW infants. A study is currently being conducted to identify the specific contributory enteral nutrition practises.(Funded by MRC/PMAC Scholarship).