PEDIATRICS Vol. 105 No. 2 February 2000, pp. 379-384

The Incidence of Necrotizing Enterocolitis After Introducing Standardized Feeding Schedules for Infants Between 1250 and 2500 Grams and Less Than 35 Weeks of Gestation

Received Nov 20, 1998; accepted May 10, 1999.

Michael D. Kamitsuka^*, Mary K. Horton^*, and Michelle A. Williams

From the Divisions of ^* Neonatal Medicine and  Perinatal Medicine, Swedish Medical Center, Seattle, Washington.

Objective.  To evaluate the incidence of necrotizing enterocolitis (NEC) after implementing standardized feeding schedules.

Method.  This was a cohort study, which retrospectively reviewed the incidence of NEC for a 3-year period before implementing feeding schedules and prospectively evaluated the incidence of NEC for a 3-year period after implementing feeding schedules in infants with birth weights between 1250 and 2500 g and <35 weeks' gestation. The feeding schedules were comprised of 3 parts. First, no group was fed within the first 24 hours of life. Feeds were started between 24 to 72 hours of life based on birth weight. Second, the initial feed was full-strength breast milk or half-strength formula. Half-strength formula was changed to full-strength formula on the fourth day for all groups. Third, the daily feeding volume increase was no greater than 20 mL/kg for all groups.

Results.  In the 477 infants before the feeding schedules, there were 23 (4.8%) cases of definite NEC defined as pneumatosis on abdominal film or NEC confirmed at the time of surgery, and in the 466 infants after the feeding schedules, there were 5 (1.1%) cases of NEC. Before the feeding schedules, those who developed NEC started feeds sooner 1.5 ± 1.5 (± standard deviation [SD]) days versus 3.0 ± .7 (±SD) days, reached full feeds sooner 4.0 ± 1.8 (± SD) days versus 9.8 ± .5 (±SD) days and were more likely to have been started on formula than those who developed NEC after implementing the feeding schedules. The mean time for NEC to occur after the feeding schedules increased from 5.9 ± 4.1 (±SD) days to 19.4 ± 16.3 (± SD) days, although not statistically significant. The number of mothers who received prenatal steroids increased after the feeding schedules. The number of infants with NEC, however, significantly decreased whether their mothers were pretreated with steroids. The risk of NEC was reduced 84% after the introduction of feeding schedules as determined by multiple logistic regression analysis and adjusting for confounding by birth weight, white race, prenatal steroid exposure, day of life of first feed, day of life to reach full feeds, and breast milk.

Conclusion.  The incidence of NEC was significantly decreased after the implementation of standardized feeding schedules, which was independent of birth weight, prenatal steroid exposure, breast milk, day of life of first feed, and the number of days to reach full feeds.  Key words:  necrotizing enterocolitis, feeding schedules, prenatal steroids, breast milk.

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