Minimal enteral feeding reduces the risk of sepsis in feed-intolerant very low birth weight newborns.

AIMS: To evaluate the efficacy and safety of minimal enteral feeding (MEF) nutritional practice in feed-intolerant very low birth weight (VLBW) infants. METHODS: A retrospective design using data reported in the clinical charts of VLBW newborns consecutively observed in neonatal intensive care units (NICU) that presents feed intolerance. During the study period, two feeding strategies were adopted: total parenteral nutrition (PN) (group 1) or PN plus MEF (group 2), for at least 24 h. Primary outcome was the time to reach full enteral feeding; secondary outcomes were the occurrence of sepsis, the time to regain birth weight, the length of hospitalization, the occurrence of necrotizing enterocolitis (NEC) Bell stage >II and death. RESULTS: In total, 102 newborns were evaluated: 51 in group 1, and 51 in group 2. Neonates in group 2 achieved full enteral nutrition earlier (8 days, interquartile range [IQR] 5) compared with subjects receiving total PN (11 days, IQR 5, p < 0.001). A reduction of sepsis episodes was observed in group 2 (15.7%) compared with group 1 (33.3%, p = 0.038). Additionally, subjects in group 2 regained their birth weight and were discharged earlier. The occurrence of NEC and death were similar in the two groups. CONCLUSION: Minimal enteral feeding in very low birth weight infants presenting feed intolerance reduces the time to reach full enteral feeding and the risk of sepsis. This feeding practice does not increase the risk of necrotizing enterocolitis and death.

Neonatal onset intestinal failure: an Italian Multicenter Study.

OBJECTIVE: To describe the natural course of intestinal failure with onset in the neonatal period to provide data regarding the occurrence and to provide a population-based survey regarding the spectrum of underlying diseases. STUDY DESIGN: We performed a retrospective chart review including infants admitted to the neonatal intensive care unit of 7 Italian tertiary care centers. Intestinal failure was defined as a primary intestinal disease that induces the need of total parenteral nutrition (PN) for more than 4 weeks or the need of partial PN for more than 3 months. RESULTS: The total number of live births during the study time within the enrolled institutions was 30 353, and the number of newborns admitted to the neonatal intensive care unit was 5088. Twenty-six patients satisfied the definition of intestinal failure; thus the occurrence rate of intestinal failure was 0.1% among live-birth newborns and 0.5% among infants at high risk. The main underlying diseases leading to intestinal failure in neonatal age were congenital intestinal defects (42.3%), necrotizing enterocolitis (30.8%), severe intestinal motility disorder (11.5%), intestinal obstruction (7.7%), structural enterocyte defects (3.8%), and meconium peritonitis (3.8%). After a follow-up of 36 months, 84.6% of patients achieved intestinal competence, 1 patient was still receiving home PN, 1 patient underwent transplantation, and 2 patients died. Cholestatic liver disease was diagnosed in 54% of observed children. CONCLUSION: An understanding of the incidence, causes, and natural history of intestinal failure would be helpful to appropriately allocate resources and to plan clinical trials.