The Relationship of Neonatal Alimentation Practices to the Occurrence of Endemic Necrotizing Enterocolitis

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Abstract
Enteric alimentation has been one of several factors implicated in the development of necrotizing enterocolitis (NEC). To examine this relationship further, the alimentation records of 19 patients who developed NEC were each compared with two matched patients controlled for birthweight and time of admission to the intensive care nursery. Parameters compared included total fluids provided, rate of enteral feed volume advancement, milk selection, and medications given. In addition, because there were no marked day-to-day differences between the mean values of most parameters and because we noted a marked fluctuation of formula intake and volume increments, we analyzed the maximum differences between the two groups. Maximum total fluids intake occurred on day 5 of life for the NEC patients and was 180.7 ± 44 ml/kg. The control group on this same day received 149.7 ± 35 ml/kg (p < 0.01). Maximum enteral intake occurred on day 8 for the NEC patients at 124.3 ± 5.7 ml/kg, whereas the control group had consumed only 83.5 ± 60 ml/kg (p < 0.05) on this matched day. The feed increment rate from initiation of feeds to day of maximum feeds was 27.8 ± 16 ml/kg/day for the NEC patients and 16.8 ± 11 for the control patients (p < 0.0005). Furthermore, during the entire study period patients who developed NEC had the greatest 1 day increment compared with the controls (56.7 ± 19.4 vs 44.6 ± 26.2 ml/kg, p < 0.05). Very rapid advancement of enteral feedings and excessive fluid volumes may predispose premature infants to the development of NEC and should be discouraged. We recommend that daily milk volume increments should not exceed 20 ml/kg/day in low birthweight neonates.

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