PURPOSE: The purpose of this study is to explain how factors related to enteral feeding regimens play a role in the pathogenesis of necrotizing enterocolitis (NEC) in preterm infants. The findings will inform multidisciplinary neonatal intensive care teams seeking to decrease the incidence of NEC and enhance preterm infant growth and development through the implementation of improved enteral feeding regimens.

SUBJECTS: Subjects included 240 preterm infants born at a birth weight less than 1500 grams and at a gestational age less than 34 weeks. The majority of the subjects were less than 32 weeks' gestational age (92.7%), less than 1250 grams (74.9%), and white, non-Hispanic in race (71.3%). The sample was equally distributed between male and female gender (51.8% male).

METHOD: This retrospective, predictive case controlled study used medical record data for infants born at the New England Medical Center (Boston, MA) from 1997 to 2003. In this matched sample, multivariate analysis techniques were used to differentiate preterm infants who developed NEC from those who did not develop NEC based on six enteral feeding factors.

RESULTS: Logistic regression indicated that administration of enteral feedings within the first 48 hours of life, enteral feeding advancement >20mL/kg/day, and enteral feedings of nutritionally fortified breast milk or infant formula were significant factors in predicting NEC. The odds of NEC were 2.9 times greater in preterm infants when the enteral feeding regimen was advanced >20mL/kg/day (P = .014). The odds of NEC significantly decreased when the preterm infant did not receive enteral feedings in the first 48 hours of life but did receive nutritionally fortified enteral substrate (P = .000).

CONCLUSIONS: The results of this study emphasize the importance of understanding the role that specific factors related to the enteral feeding regimen play in the pathogenesis of neonatal comorbidities such as NEC. This sample of preterm infants was less likely to develop NEC after successfully progressing to a point on the enteral feeding regimen at which nutritional fortification was added to the enteral substrate. The findings highlight the need to focus future research efforts on studying the time at which a NEC diagnosis occurs during the enteral feeding regimen and the potential role that nutritional fortification plays in this morbidity.