What is the role of enteral feedings in the etiology of necrotizing enterocolitis (NEC)?

Updated: Dec 27, 2017
  • Author: Shelley C Springer, JD, MD, MSc, MBA, FAAP; Chief Editor: Muhammad Aslam, MD  more...
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It has long been suspected that the initiation of early enteral feedings is associated with NEC, sparked in part by the observation that unfed infants rarely develop NEC. Some series have reported decreased rates of NEC when feeding volumes are reduced, however, a more recent multicenter, matched case-control study (EPIFLORE: Epidemiologic Study of Flora) comprising data from 64 neonatal intensive care units, reported the opposite. [5]  Earlier, in a prospective randomized trial, Book et al found a significant increase in the development of NEC among preterm infants fed a hyperosmolar elemental formula compared with those fed a milk formula. [13] The complex relationship between feeding and NEC is further confounded by the recognition that NEC is much more likely to occur in infants who receive packed red blood cell (RBC) transfusion, especially in infants who are enterally feeding. [14]  Up to one third of all NEC cases in very low birth weight infants may occur within 24-48 hours after RBC transfusion, with the highest risk potentially in infants transfused with the most severe anemia. [15]

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