Withholding Enteral Feeding and Its Clinical Consequences in Extremely Low Birth Weight Infants during NICU Stay / 대한주산의학회잡지

ABSTRACT

PURPOSE: To evaluate the causes of nil per os (NPO) before reaching full enteral feeding and compare the clinical outcomes of extremely low birth weight infant (ELBWI) by NPO duration. METHODS: We retrospectively reviewed the medical records of 92 ELBWI who were born and admitted to Neonatal intensive care unit (NICU) of Seoul National University Children's Hospital from January 2009 to December 2011. We analyzed the perinatal factors and causes of NPO. To compare neurodevelopmental outcomes and growth, we used K-ASQ (Korean ages & stages questionnaires) and growth Z-score. RESULTS: There were total 163 fasting episodes before reaching full enteral feeding. Mean NPO time was 6.7+/-5.6 days and mean frequency of NPO was 1.8 episodes. Most common cause of NPO was the medication for patent ductus arteriosus (PDA) closure (47.5%) and the next was the feeding intolerance (25.3%). Longer NPO group (more than 7 days) showed longer time to full enteral feeding and hospital day. Incidence of necrotizing enterocolitis was significantly higher in the longer NPO group. But there was no difference between two groups in the incidence of sepsis, cholestasis, and osteopenia. Changes in height Z-score from birth to postmenstrual age 35 weeks were significantly higher in the longer NPO group. In longer NPO group, catch-up of weight Z-score at CA 8 months was poor. And number of patients with score under cutoff level in K-ASQ was higher. CONCLUSION: NPO duration seems to be related with long term growth and neurodevelopment. Effort to minimize fasting time is needed by keeping enteral feeding during PDA medication and active management for feeding intolerance.