Mo Ingrid, Lapillonne Alexandre, van den Akker C H P, Khashu Minesh, Johnson Mark J, McElroy Steven J, Zachariassen Gitte
Department of Clinical Research, University of Southern Denmark, 5000, Odense, Denmark.
Department of Neonatology, Necker-Enfants Malades Hospital, EHU 7328 PACT, University of Paris Cite, Paris, France.
Pediatr Res. 2024 Jul 11. doi: 10.1038/s41390-024-03386-y.
Nutritional management of preterm infants recovering from necrotizing enterocolitis (NEC) or focal intestinal perforation (FIP) is challenging, especially in infants managed surgically. The logistics of how, when, and what to feed are unclear and current nutritional practices are primarily based on physiological principles and consensus opinion in individual units, rather than high-quality evidence. The aim of this narrative review is to summarize the literature on nutritional management after NEC or FIP in preterm infants: when to restart enteral nutrition, type of enteral nutrition to use, and how to advance nutrition. We also discuss treatment of micronutrient deficiencies, cholestasis, replacement of stoma losses, and optimal time of stoma closure. In conclusion, there are in sufficient high-quality studies available to provide evidence-based recommendations on the best nutritional practice after NEC or FIP in preterm infants. A local or national consensus based early nutrition guideline agreed upon by a multidisciplinary team including pediatric surgeons, pediatricians/neonatologists, nurses, and nutritionists is recommended. Further studies are urgently needed. IMPACT: There is no good quality evidence or nutritional standard across neonatal units treating infants after medical or surgical NEC or FIP. With this review we hope to start providing some consistency across patients and between providers treating patients with NEC and FIP. Mother's own milk is recommended when restarting enteral nutrition after NEC or FIP. In the absence of high-quality evidence, a consensus based early nutrition guideline agreed upon by a multidisciplinary team is recommended. Nutritional research projects are urgently needed in NEC and FIP patients.
对于从坏死性小肠结肠炎（NEC）或局灶性肠穿孔（FIP）中恢复的早产儿进行营养管理具有挑战性，尤其是对于接受手术治疗的婴儿。关于如何、何时以及喂什么的具体安排尚不清楚，目前的营养实践主要基于生理原则和各单位的共识意见，而非高质量证据。本叙述性综述的目的是总结有关早产儿NEC或FIP后营养管理的文献：何时重新开始肠内营养、使用的肠内营养类型以及如何推进营养。我们还讨论了微量营养素缺乏的治疗、胆汁淤积、造口丢失的补充以及造口关闭的最佳时机。总之，目前尚无足够的高质量研究可为早产儿NEC或FIP后的最佳营养实践提供循证建议。建议由包括小儿外科医生、儿科医生/新生儿科医生、护士和营养师在内的多学科团队达成基于当地或全国共识的早期营养指南。迫切需要进一步的研究。影响：在治疗内科或外科NEC或FIP后婴儿的新生儿单位中，没有高质量的证据或营养标准。通过本综述，我们希望开始在治疗NEC和FIP患者的不同医疗服务提供者之间以及患者之间实现一定程度的一致性。在NEC或FIP后重新开始肠内营养时，建议使用母乳。在缺乏高质量证据的情况下，建议由多学科团队达成基于共识的早期营养指南。迫切需要针对NEC和FIP患者开展营养研究项目。
