Association between timing of re-introduction of enteral feeding and short-term outcomes following laparotomy for necrotising enterocolitis

  • Author Footnotes
    1 Present address: Paediatric Surgery Department, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK
    Oliver Burdall
    Correspondence
    Corresponding author.
    Footnotes
    1 Present address: Paediatric Surgery Department, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK
    Affiliations
    Norfolk and Norwich NHS Trust, Norfolk and Norwich Hospital, Colney Lane, Norwich NR4 7UY, UK
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  • Benjamin Allin
    Affiliations
    John Radcliffe Hospital, Oxford University & Oxford University Hospitals NHS Trust, Headington, Headley Way, Oxford OX3 9DU, UK

    National Perinatal Epidemiology Unit, University of Oxford, Headington, Old Road Campus,, Oxford OX3 7LF, UK
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  • Kathryn Ford
    Affiliations
    John Radcliffe Hospital, Oxford University & Oxford University Hospitals NHS Trust, Headington, Headley Way, Oxford OX3 9DU, UK
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  • Amit Gupta
    Affiliations
    John Radcliffe Hospital, Oxford University & Oxford University Hospitals NHS Trust, Headington, Headley Way, Oxford OX3 9DU, UK
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  • Kokila Lakhoo
    Affiliations
    John Radcliffe Hospital, Oxford University & Oxford University Hospitals NHS Trust, Headington, Headley Way, Oxford OX3 9DU, UK
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  • Marian Knight
    Affiliations
    National Perinatal Epidemiology Unit, University of Oxford, Headington, Old Road Campus,, Oxford OX3 7LF, UK
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  • Nigel J Hall
    Affiliations
    Faculty of Medicine, University Surgery Unit, University of Southampton, University Road, Southampton SO17 1BJ, UK
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  • For and on behalf of the BAPS-CASS NEC Collaboration
  • Author Footnotes
    1 Present address: Paediatric Surgery Department, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK
Published:September 16, 2021DOI:https://doi.org/10.1016/j.jpedsurg.2021.09.006

      Highlights

      • First population-based description of feeding strategies of surgically managed NEC on a country-wide level.
      • Most infants have feed re-introduced between 8 and 28 days after surgery, but one fifth re-start feeds at 7 days or less.
      • Re-introduction of feeds at 7 days or less is not associated with worse outcome at 28 days.

      Abstract

      Purpose

      To investigate the relationship between timing of re-introduction of feeds following surgery for Necrotising Enterocolitis (NEC) and important early outcomes.

      Methods

      Secondary analysis of prospectively collected data from paediatric surgical units in UK/Ireland of infants who underwent laparotomy for NEC between 01/03/2013 and 28/02/2014. Multivariable logistic regression analysis was used to compare the relationship of early (≤ 7 days) and later (8–27 days) re-introduction of feeding after surgery on death or need for PN at 28 days, correcting for known cofounders.

      Results

      41/143 infants (29%) received early and 102/143 infants (71%) had delayed reintroduction of feeding. Infants in the early feeding group had a higher gestational age at birth, higher proportion of growth restriction, lower inotrope requirement, and weremore likely to have undergone primary anastomosis. Following adjustment there was no statistically significant difference detected in the rate of death or need for PN at 28 days, adjusted OR 0.4 (95% CI 0.2–1.1), noting the limited statistical power of this comparison.

      Conclusions

      There is no evidence from this study to support a minimum period of 7 days nil by mouth post laparotomy for infants with NEC. Early feed reintroduction following laparotomy for NEC is safe in appropriate cases.

      Level of evidence

      Level II – Treatment Study Group; Prospective comparative study.

      Keywords

      Abbreviations:

      NEC (necrotising enterocolitis), PN (parenteral nutrition), SIP (spontaneous intestinal perforation), SGA (small of gestinational age), IQR (interquartile range), OR (odds ratio), PNALD (parenteral nutrition association liver disease)
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