What to feed very preterm infants to avoid necrotizing enterocolitis

Abstract

Necrotizing enterocolitis (NEC) continues to be a scourge for the neonatal community. Its occurrence is infrequent enough to make NEC difficult to study, and there are no reliable predictors of who is at highest risk to refine populations for study. Further, NEC occurs in the clinical course beyond the initial period of acute disease. NEC is associated with enteral feeding, a necessary intervention if infants are to survive and grow. The question is what to feed and how to supplement these feeds for optimal growth. A simple question has become complex because the options are increasing. Basic nutrition can be provided by a variety of formulas, fresh human milk, or frozen/banked human milk, with fresh human milk being the preferred basic nutritional source. Caloric supplements vary — liquid or powdered, of animal or human origin — and price and availability influence the decision of how to fortify. Probiotics in the form of various organisms or mixtures of organisms seem to decrease NEC but standardized preparations are not widely available. Finally, prebiotics, agents that stimulate the growth of “good” bacteria in the gut, could be helpful. The permeations of the various combinations are almost endless, and the multiple possibilities are not practical to substantially test in trials. However, in this issue of The Journal, Dilli et al report a 4-armed randomized controlled trial comparing no probiotic to a probiotic with or without the addition of the prebiotic inulin. The probiotic was associated with less NEC and less sepsis, but with no effect from the prebiotic. This report does not end the discussion about prebiotics because there are many other candidates that could be tested.Article page 545▶ Necrotizing enterocolitis (NEC) continues to be a scourge for the neonatal community. Its occurrence is infrequent enough to make NEC difficult to study, and there are no reliable predictors of who is at highest risk to refine populations for study. Further, NEC occurs in the clinical course beyond the initial period of acute disease. NEC is associated with enteral feeding, a necessary intervention if infants are to survive and grow. The question is what to feed and how to supplement these feeds for optimal growth. A simple question has become complex because the options are increasing. Basic nutrition can be provided by a variety of formulas, fresh human milk, or frozen/banked human milk, with fresh human milk being the preferred basic nutritional source. Caloric supplements vary — liquid or powdered, of animal or human origin — and price and availability influence the decision of how to fortify. Probiotics in the form of various organisms or mixtures of organisms seem to decrease NEC but standardized preparations are not widely available. Finally, prebiotics, agents that stimulate the growth of “good” bacteria in the gut, could be helpful. The permeations of the various combinations are almost endless, and the multiple possibilities are not practical to substantially test in trials. However, in this issue of The Journal, Dilli et al report a 4-armed randomized controlled trial comparing no probiotic to a probiotic with or without the addition of the prebiotic inulin. The probiotic was associated with less NEC and less sepsis, but with no effect from the prebiotic. This report does not end the discussion about prebiotics because there are many other candidates that could be tested. Article page 545▶ The ProPre-Save Study: Effects of Probiotics and Prebiotics Alone or Combined on Necrotizing Enterocolitis in Very Low Birth Weight InfantsThe Journal of PediatricsVol. 166Issue 3PreviewTo test the efficacy of probiotic and prebiotic, alone or combined (synbiotic), on the prevention of necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants. Full-Text PDF