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Gastric residuals and their relationship to necrotizing enterocolitis
in very low birth weight infants.Pediatrics.
2004 Jan;113(1 Pt 1):50-3.
OBJECTIVE: To
determine the characteristics of gastric residuals in very low birth
weight (VLBW; <or=1500 g birth weight) infants with and without
necrotizing enterocolitis (NEC). METHODS: Case-control study compared
51 VLBW infants who had proven NEC (pneumatosis intestinalis, portal
venous gas, and/or perforation; excluding spontaneous gastrointestinal
perforations) with 102 control subjects (without suspected or proven
NEC) who were matched for birth weight, gestational age, race, and sex
and were born January 1996 to December 2001. The age in days at
diagnosis of NEC was identified in infants with NEC, and feeding
characteristics were recorded for the previous 6 days. Feeding
characteristics were recorded for control subjects for the
corresponding time period. RESULTS: The median birth weight was 822 g
and median gestational age was 26 weeks in both groups. Feeds were
started on the fifth day, with a planned increase to full feeds over
10 days (median) in both groups. Median time to full feeds was 13 days
in both groups. Median age of onset of NEC was day 24. The total
residuals as a percentage of total feed volume (the primary outcome),
maximum residual in the previous 6 days, maximum residual as a
percentage of the feed, maximum residuals over the 6 days, and the
percentage of feeds with residuals were higher in the NEC group. The
maximum residual (median [25th-75th centiles]) was as follows: control
subjects: 2 mL per feed (0.5-3.5) or 14% of a feed (4-33); NEC group:
4.5 mL per feed (1.5-9.8) or 40% of a feed (24-61). The total
residuals as percentage of feeds and the average of maximum residuals
increased in the NEC group from the first 3 days to the 3 days before
diagnosis of NEC, but a similar increase was not noted for control
subjects. CONCLUSIONS: VLBW infants who developed NEC had more gastric
residuals. However, there was overlap with the normal control
subjects. Of the gastric residual data, the maximum residual seems to
be the best predictor for NEC in the subsequent days.
The
incidence of necrotizing enterocolitis after introducing standardized
feeding schedules for infants between 1250 and 2500 grams and less
than 35 weeks of gestation.Pediatrics.
2000 Feb;105(2):379-84.
OBJECTIVE. To
evaluate the incidence of necrotizing enterocolitis (NEC) after
implementing standardized feeding schedules. METHOD. This was a cohort
study, which retrospectively reviewed the incidence of NEC for a
3-year period before implementing feeding schedules and prospectively
evaluated the incidence of NEC for a 3-year period after implementing
feeding schedules in infants with birth weights between 1250 and 2500
g and <35 weeks' gestation. The feeding schedules were comprised of 3
parts. First, no group was fed within the first 24 hours of life.
Feeds were started between 24 to 72 hours of life based on birth
weight. Second, the initial feed was full-strength breast milk or
half-strength formula. Half-strength formula was changed to
full-strength formula on the fourth day for all groups. Third, the
daily feeding volume increase was no greater than 20 mL/kg for all
groups. RESULTS. In the 477 infants before the feeding schedules,
there were 23 (4.8%) cases of definite NEC defined as pneumatosis on
abdominal film or NEC confirmed at the time of surgery, and in the 466
infants after the feeding schedules, there were 5 (1.1%) cases of NEC.
Before the feeding schedules, those who developed NEC started feeds
sooner 1.5 +/- 1.5 (+/- standard deviation [SD]) days versus 3.0 +/-.7
(+/-SD) days, reached full feeds sooner 4.0 +/- 1.8 (+/- SD) days
versus 9.8 +/-.5 (+/-SD) days and were more likely to have been
started on formula than those who developed NEC after implementing the
feeding schedules. The mean time for NEC to occur after the feeding
schedules increased from 5.9 +/- 4.1 (+/-SD) days to 19.4 +/- 16.3
(+/- SD) days, although not statistically significant. The number of
mothers who received prenatal steroids increased after the feeding
schedules. The number of infants with NEC, however, significantly
decreased whether their mothers were pretreated with steroids. The
risk of NEC was reduced 84% after the introduction of feeding
schedules as determined by multiple logistic regression analysis and
adjusting for confounding by birth weight, white race, prenatal
steroid exposure, day of life of first feed, day of life to reach full
feeds, and breast milk. CONCLUSION. The incidence of NEC was
significantly decreased after the implementation of standardized
feeding schedules, which was independent of birth weight, prenatal
steroid exposure, breast milk, day of life of first feed, and the
number of days to reach full feeds.
Necrotizing enterocolitis: a 12-year
retrospective study.Klin
Padiatr. 1995 Jan-Feb;207(1):28-33.
Necrotizing
enterocolitis (NEC) is the most relevant intestinal acquired
complication during the neonatal period. Due to the improvements in
perinatal medicine during the last decade, we wanted to work out
possible differences in the incidence, diagnosis and clinical courses
of NEC during a 12 years period. PATIENTS AND METHODS: All premature
or term newborns were eligible for the study, if a necrotizing
enterocolitis > or = stage 2a according to Bell was diagnosed between
January 1980-December 1991. RESULTS: During the study period, 90
preterm or term newborns were treated for necrotizing enterocolitis,
19 infants were admitted to our hospital for therapy of established
NEC from other hospitals. Forty-five infants had a birthweight of < or
= 1500 g. During the years 1987-1991 there was an increase in the
incidence (4-12/year, median 9/year, compared to 0-6, median 3/year
during the period 1980-1986). This was paralleled by an increase in
very low birthweight infants admitted to the NICU (1980-1986:
35-45/year, 1987-1991: 83-108/year). Prominent clinical signs:
abdominal distension (85 infants), increased gastric residuals (72),
bright blood from rectum (56). Median time of manifestation in infants
< or = 30 weeks was 17 days, for infants of 31-34 weeks 8 days and for
infants of > or = 35 weeks of gestation 4 days. Eleven infants were
fed parenterally exclusively before NEC, 12 infants received
exclusively breast milk, 67 formula. Surgical treatment was indicated
in 51 infants (indication: intestinal perforation or peritonitis
diagnosed by abdominal paracentesis). Seventy-one infants survived, in
17 infants who died, NEC or secondary disorders were the main cause.
CONCLUSION: With increasing numbers of very preterm infants, the
relevance of NEC becomes more and more important. Concepts of
prevention and early diagnosis further have to be worked out.
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