Hock Alison Maria, Chen Yong, Miyake Hiromu, Koike Yuhki, Seo Shogo, Pierro Agostino
Division of General and Thoracic Surgery, Translational Medicine Program, SickKids - The Hospital for Sick Children, Toronto, Ontario, Canada.
Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore.
Eur J Pediatr Surg. 2018 Feb;28(1):44-50. doi: 10.1055/s-0037-1604436. Epub 2017 Aug 24.
Management of necrotizing enterocolitis (NEC) consists of cessation of enteral feeding, intravenous antibiotic administration, and supportive treatment. There is no evidence-based recommendation regarding when to restart feeding after a NEC episode. We performed a systematic review and meta-analysis to examine the effect of timing of enteral feeding reinitiation on NEC recurrence.
MEDLINE, Embase, Google scholar, and Cochrane databases were searched. Human studies evaluating enteral feeding timing with a primary outcome of NEC recurrence were included. A total of 2,257 titles or abstracts were screened, and 47 full-text articles were analyzed. A systematic review and meta-analysis comparing NEC recurrence and other associated outcomes between early (<5 days after NEC diagnosis) and delayed (>5 days) initiation of enteral feeding after NEC were performed according to the PRISMA statement. The meta-analysis data were analyzed using RevMan 5.3 to estimate odds ratios (ORs) with 95% confidence intervals (CIs).
Two retrospective observational studies met the inclusion criteria, comprising 56 cases in which enteral feeding was started early and 35 cases of delayed enteral feeding initiation. There were no randomized controlled trials (RCTs). The recurrence rates of NEC were unchanged between early (5.4%) and delayed (8.6%) enteral feeding groups (pooled OR = 0.61; 95% CI: 0.12-3.16; = 0.56; = 0%). Catheter-related sepsis (pooled OR = 0.20; 95% CI: 0.01-3.29; = 0.26; = 67%) and post-NEC stricture (pooled OR = 0.28; 95% CI: 0.07-1.18; = 0.08; = 23%) rates were not different between early and delayed enteral feeding groups.
Initiating early enteral feeding, within 5 days of NEC diagnosis, is not associated with adverse outcomes, including NEC recurrence. In addition, catheter-related sepsis and post-NEC stricture rates were unchanged between early and delayed enteral feeding groups after NEC. However, the quality of the evidence from the review of literature is suboptimal. A further RCT is needed to confirm these results.
坏死性小肠结肠炎（NEC）的管理包括停止肠内喂养、静脉注射抗生素以及支持治疗。对于NEC发作后何时重新开始喂养，尚无基于证据的推荐意见。我们进行了一项系统评价和荟萃分析，以研究肠内喂养重新开始的时机对NEC复发的影响。
检索了MEDLINE、Embase、谷歌学术和Cochrane数据库。纳入以NEC复发作为主要结局来评估肠内喂养时机的人体研究。共筛选了2257篇标题或摘要，分析了47篇全文文章。根据PRISMA声明，对NEC诊断后早期（<5天）和延迟（>5天）开始肠内喂养的NEC复发及其他相关结局进行了系统评价和荟萃分析。使用RevMan 5.3分析荟萃分析数据，以估计具有95%置信区间（CI）的比值比（OR）。
两项回顾性观察性研究符合纳入标准，包括56例早期开始肠内喂养的病例和35例延迟开始肠内喂养的病例。没有随机对照试验（RCT）。早期（5.4%）和延迟（8.6%）肠内喂养组之间NEC的复发率没有变化（合并OR = 0.61；95% CI：0.12 - 3.16；I² = 0.56；P = 0%）。导管相关败血症（合并OR = 0.20；95% CI：0.01 - 3.29；I² = 0.26；P = 67%）和NEC后狭窄（合并OR = 0.28；95% CI：0.07 - 1.18；I² = 0.08；P = 23%）的发生率在早期和延迟肠内喂养组之间没有差异。
在NEC诊断后5天内尽早开始肠内喂养与不良结局无关，包括NEC复发。此外，NEC后早期和延迟肠内喂养组之间导管相关败血症和NEC后狭窄的发生率没有变化。然而，文献综述的证据质量欠佳。需要进一步的RCT来证实这些结果。
