Association between timing of re-introduction of enteral feeding and short-term outcomes following laparotomy for Necrotising Enterocolitis
Association between timing of re-introduction of enteral feeding and short-term outcomes following laparotomy for Necrotising Enterocolitis
Purpose: To investigate the relationship between timing of re-introduction of feeds following surgery for Necrotising Enterocolitis (NEC) and important early outcomes.
Methods: Secondary analysis of prospectively collected data from paediatric surgical units in UK/Ireland of infants who underwent laparotomy for NEC between 01/03/2013 and 28/02/2014. Multivariable logistic regression analysis was used to compare the relationship of early (≤ 7 days) and later (8-27 days) re-introduction of feeding after surgery on death or need for PN at 28 days, correcting for known cofounders.
Results: 41/143 infants (29%) received early and 102/143 infants (71%) had delayed reintroduction of feeding. Infants in the early feeding group had a higher gestational age at birth, higher proportion of growth restriction, lower inotrope requirement, and weremore likely to have undergone primary anastomosis. Following adjustment there was no statistically significant difference detected in the rate of death or need for PN at 28 days, adjusted OR 0.4 (95% CI 0.2-1.1), noting the limited statistical power of this comparison.
Conclusions: There is no evidence from this study to support a minimum period of 7 days nil by mouth post laparotomy for infants with NEC. Early feed reintroduction following laparotomy for NEC is safe in appropriate cases.
Level of evidence: Level II - Treatment Study Group; Prospective comparative study.
Keywords: Bowel rest; Necrotising enterocolitis (NEC); Neonatal; Total parenteral nutrition (TPN); Treatment.
Bowel rest, Necrotising enterocolitis (NEC), Neonatal, Total parenteral nutrition (TPN), Treatment
Burdall, Oliver
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Allin, Benjamin
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Ford, Kathryn
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Gupta, Amit
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Lakhoo, Kokila
3946454d-65f8-4c24-9f20-58f7941543ab
Knight, Marian
124145dc-d997-40ea-b939-e653d2f0ddd8
Hall, Nigel
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BAPS-CASS NEC Collaboration
Burdall, Oliver
d3a2efe5-17ef-4afd-a484-0923875d695c
Allin, Benjamin
f626d966-141b-4928-89f1-aeab8b261390
Ford, Kathryn
831491c4-a679-432c-962a-3e995ee6c1a7
Gupta, Amit
0bf3f76d-d1ac-4e06-b5ba-3fe1d12d2559
Lakhoo, Kokila
3946454d-65f8-4c24-9f20-58f7941543ab
Knight, Marian
124145dc-d997-40ea-b939-e653d2f0ddd8
Hall, Nigel
6919e8af-3890-42c1-98a7-c110791957cf
BAPS-CASS NEC Collaboration
(2021)
Association between timing of re-introduction of enteral feeding and short-term outcomes following laparotomy for Necrotising Enterocolitis.
Journal of Pediatric Surgery.
(doi:10.1016/j.jpedsurg.2021.09.006).
Abstract
Purpose: To investigate the relationship between timing of re-introduction of feeds following surgery for Necrotising Enterocolitis (NEC) and important early outcomes.
Methods: Secondary analysis of prospectively collected data from paediatric surgical units in UK/Ireland of infants who underwent laparotomy for NEC between 01/03/2013 and 28/02/2014. Multivariable logistic regression analysis was used to compare the relationship of early (≤ 7 days) and later (8-27 days) re-introduction of feeding after surgery on death or need for PN at 28 days, correcting for known cofounders.
Results: 41/143 infants (29%) received early and 102/143 infants (71%) had delayed reintroduction of feeding. Infants in the early feeding group had a higher gestational age at birth, higher proportion of growth restriction, lower inotrope requirement, and weremore likely to have undergone primary anastomosis. Following adjustment there was no statistically significant difference detected in the rate of death or need for PN at 28 days, adjusted OR 0.4 (95% CI 0.2-1.1), noting the limited statistical power of this comparison.
Conclusions: There is no evidence from this study to support a minimum period of 7 days nil by mouth post laparotomy for infants with NEC. Early feed reintroduction following laparotomy for NEC is safe in appropriate cases.
Level of evidence: Level II - Treatment Study Group; Prospective comparative study.
Keywords: Bowel rest; Necrotising enterocolitis (NEC); Neonatal; Total parenteral nutrition (TPN); Treatment.
Text
JPEDSURG-D-21-00413_R1 (1)
- Accepted Manuscript
More information
Accepted/In Press date: 10 September 2021
e-pub ahead of print date: 17 September 2021
Additional Information:
Funding Information:
MK is an NIHR Senior Investigator. BSRA is funded by an NIHR Doctoral Research Fellowship. This publication presents independent research funded by the National Institute for Health Research (NIHR).
Publisher Copyright:
© 2021
Keywords:
Bowel rest, Necrotising enterocolitis (NEC), Neonatal, Total parenteral nutrition (TPN), Treatment
Identifiers
Local EPrints ID: 451813
URI: http://eprints.soton.ac.uk/id/eprint/451813
ISSN: 0022-3468
PURE UUID: fe1c90cb-bbcd-4098-9464-ac2ab11ac29b
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Date deposited: 28 Oct 2021 16:33
Last modified: 17 Mar 2024 06:52
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Contributors
Author:
Oliver Burdall
Author:
Benjamin Allin
Author:
Kathryn Ford
Author:
Amit Gupta
Author:
Kokila Lakhoo
Author:
Marian Knight
Corporate Author: BAPS-CASS NEC Collaboration
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