Arbra Chase A, Oprisan Andra, Wilson Dulaney A, Ryan Rita M, Lesher Aaron P
Department of Surgery, Medical University of South Carolina, Charleston, SC.
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC.
J Pediatr Surg. 2018 Jun;53(6):1187-1191. doi: 10.1016/j.jpedsurg.2018.02.082. Epub 2018 Mar 7.
For infants with necrotizing enterocolitis (NEC) treated nonoperatively, no consensus exists on the optimal fasting period prior to reintroducing feeds after NEC. We report our experience with early (<7days) and late (≥7days) refeeding in this population.
A chart review of infants with NEC born between 2006 and 2016 was performed. Data elements include demographics, comorbidities, day of diagnosis, Bell's stage, recurrence, strictures, length of stay and mortality, and were grouped into early and late refeeding. T-tests were used for means and chi-squared tests for distribution of proportions. Linear and logistic regressions were used to further evaluate the association of length of stay, stricture, recurrence, and death with time to refeeding.
Of 228 NEC patients, 149(65%) were treated nonoperatively (Bell Stages I, IIA, IIB, IIIA). Eleven patients were excluded owing to never restarting feeds, largely secondary to early death. The early (n=40) and late refeeding (n=98) groups were not significantly different with regard to mean gestational age at birth, race, birth weight, day of life at NEC diagnosis, or cardiac disease. NEC Stage was significantly different (p<0.001). The late group had significantly more Stage IIB patients (p=.02), and the early group had more stage I patients (p=<0.01). After adjusting for Bell's stage, the odds of NEC recurrence, death, and the composite outcome of recurrence or stricture or death were not significantly different between early and late groups.
No standardized guidelines exist for restarting enteral nutrition following medical NEC. In patients managed nonoperatively, early reintroduction of feeding was not significantly associated with increased NEC recurrence, mortality, or stricture.
Treatment Study - Level III.
对于非手术治疗的坏死性小肠结肠炎（NEC）婴儿，在NEC后重新引入喂养之前的最佳禁食期尚无共识。我们报告了在这一人群中早期（<7天）和晚期（≥7天）重新喂养的经验。
对2006年至2016年出生的NEC婴儿进行病历回顾。数据元素包括人口统计学、合并症、诊断日期、贝尔分期、复发、狭窄、住院时间和死亡率，并分为早期和晚期重新喂养。采用t检验分析均值，卡方检验分析比例分布。使用线性和逻辑回归进一步评估住院时间、狭窄、复发和死亡与重新喂养时间的关联。
在228例NEC患者中，149例（65%）接受了非手术治疗（贝尔分期I、IIA、IIB、IIIA）。11例患者因从未重新开始喂养而被排除，主要是由于早期死亡。早期重新喂养组（n = 40）和晚期重新喂养组（n = 98）在出生时的平均胎龄、种族、出生体重、NEC诊断时的日龄或心脏病方面无显著差异。NEC分期有显著差异（p<0.001）。晚期组IIB期患者明显更多（p = 0.02），早期组I期患者更多（p<0.01）。在调整贝尔分期后，早期和晚期组之间NEC复发、死亡以及复发或狭窄或死亡的复合结局的几率无显著差异。
对于内科治疗的NEC后重新开始肠内营养，尚无标准化指南。在非手术治疗的患者中，早期重新引入喂养与NEC复发、死亡率或狭窄增加无显著关联。
治疗研究 - III级。
