PEDIATRICS Vol. 115 No. 5 May 2005, pp. 1439 (doi:10.1542/10.1542/peds.2005-0255)
Rapid Feeding Volume Advancements: Uncertainty About the Effect on Necrotizing Enterocolitis Incidence: In Reply
Judith Caple, RNC, MSN, NNPDebra Armentrout, RNC, MSN, NNP
Valerie Huseby, RNC, MSN, NNP
Brenda Halbardier, RNC, MSN, NNP
Jose Garcia, MD
John W. Sparks, MD
Fernando R. Moya, MD
Department of Pediatrics
University of Texas–Houston Medical School
Houston, TX 77030
We appreciate the comments of Degraeuwe and Blanco. In their letter these authors conclude that our findings are in good agreement with those of the only 2 other randomized trials of this subject, summarized by Kennedy and Tyson in a recent systematic review.1 None of the 3 studies reviewed by Kennedy and Tyson reported a significant increase in the incidence of necrotizing enterocolitis (NEC). Furthermore, the relative risk for NEC reported in this review is remarkably close to a position of equipoise (relative risk: 0.97; 95% confidence interval: 0.50–1.87). Although we agree with Degraeuwe and Blanco that this evidence is not definitive proof of safety, we did not recommend adopting the practice of more rapid advancement of feedings. Moreover, using the same rationale, one should question the validity of advancing feedings at a slower pace, which is equally unproven. Thus, we concluded our article with a call for a large, multicenter, prospective trial with a sample size large enough to answer this question more definitively.
Although the suggestion that additional trials of feeding methods should use survival and neurodevelopmental outcomes as primary end points is laudable, conducting such trials would be very difficult, especially considering the low occurrence of death, severe complications such as NEC, and neurodevelopmental abnormalities in premature infants such as those included in our study (1000–2000 g). For instance, to demonstrate that the incidence of NEC observed in our study group (4%) is significantly higher than that of the control group (2.5%) with an 
of .05 and ß of .20, we would have needed to enroll 
2193 infants per group.
We firmly believe that sepsis and NEC are not equivalent surrogate outcome measures and did not comment on the former complication in our study. Nonetheless, we agree with Degraeuwe and Blanco in recognizing the impact of infection on neonatal outcome.2
REFERENCES
- Kennedy KA, Tyson JE. Rapid versus slow rate of advancement of feedings for promoting growth and preventing necrotizing enterocolitis in parenterally fed low-birth-weight infants [Cochrane review]. In: The Cochrane Library. Oxford, United Kingdom: Update Software; 2005: In press
- Stoll BJ, Hansen NI, Adams-Chapman I, et al. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection.
JAMA. 2004;292
:2357
–2365
[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics
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Related articles in Pediatrics:
- Rapid Feeding Volume Advancements: Uncertainty About the Effect on Necrotizing Enterocolitis Incidence
- Pieter L. J. Degraeuwe and Carlos E. Blanco
Pediatrics 2005 115: 1439.[Extract] [Full Text]
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