Nil-Per-Os Days and Necrotizing Enterocolitis in Extremely Preterm Infants

Abstract

Objective This study aims to evaluate the association between nil-per-os (NPO) days and development of necrotizing enterocolitis (NEC) in extremely preterm neonates (<29 weeks gestational age).

Study Design A case–control study of 234 extremely preterm neonates who developed stage II or III NEC and 467 matched control infants admitted to participating sites in the Canadian Neonatal Network between 2010 and 2011 was conducted. The number and percentage of NPO days before the development of NEC was compared with the equivalent period in control infants using logistic regression.

Results Infants with NEC were NPO on average 5.6 days (28% of days before NEC) versus 3.7 days (19% of equivalent days; p < 0.01) among controls. NEC cases required more days of inotropic support, antibiotic use, and had higher rates of patent ductus arteriosus (PDA). After adjusting for inotrope use, PDA, antibiotics, and severity of illness, for each additional NPO day the adjusted odds for NEC increased by 1.08 (95% confidence interval: 1.04–1.12).

Conclusion Among extremely preterm neonates, those who developed NEC were NPO for a longer period of time than control infants who were NEC-free. We speculate that delayed initiation or interruption of feeding may be a potent risk factor for NEC.

Keywords

enteral nutrition - gut colonization - infant - premature - intestinal microbiome

Site Investigators for the Canadian Neonatal Network

Prakesh S. Shah (Director, Canadian Neonatal Network and Site Investigator, Mount Sinai Hospital), Mount Sinai Hospital, Toronto, Ontario; Adele Harrison, Victoria General Hospital, Victoria, British Columbia; Anne Synnes, British Columbia Children's Hospital, Vancouver, British Columbia; Zenon Cieslak, Royal Columbian Hospital, New Westminster, British Columbia; Todd Sorokan, Surrey Memorial Hospital, Surrey, British Columbia; Wendy Yee, Foothills Medical Centre, Calgary, Alberta; Khalid Aziz, Royal Alexandra Hospital, Edmonton, Alberta; Zarin Kalapesi, Regina General Hospital, Regina, Saskatchewan; Koravangattu Sankaran, Royal University Hospital, Saskatoon, Saskatchewan; Mary Seshia, Winnipeg Health Sciences Centre, Winnipeg, Manitoba; Ruben Alvaro, St. Boniface General Hospital, Winnipeg, Manitoba; Sandesh Shivananda, Hamilton Health Sciences Centre, Hamilton, Ontario; Orlando Da Silva, London Health Sciences Centre, London, Ontario; Chuks Nwaesei, Windsor Regional Hospital, Windsor, Ontario; Kyong-Soon Lee, Hospital for Sick Children, Toronto, Ontario; Michael Dunn, Sunnybrook Health Sciences Centre, Toronto, Ontario; Nicole Rouvinez-Bouali, Children's Hospital of Eastern Ontario and Ottawa General Hospital, Ottawa, Ontario; Kimberly Dow, Kingston General Hospital, Kingston, Ontario; Lajos Kovacs, Jewish General Hospital, Montréal, Québec; Keith Barrington, Hôpital Sainte-Justine, Montréal, Québec; Bruno Piedboeuf, Centre Hospitalier Universitaire de Québec, Sainte Foy, Patricia Riley, Montréal Children's Hospital, Montréal, Québec; Daniel Faucher, Royal Victoria Hospital, Montréal, Québec; Valerie Bertelle, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec; Rody Canning, Moncton Hospital, Moncton, New Brunswick; Barbara Bulleid, Dr. Everett Chalmers Hospital, Fredericton, New Brunswick; Cecil Ojah, Saint John Regional Hospital, Saint John, New Brunswick; Wayne Andrews, Janeway Children's Health and Rehabilitation Centre, St. John's, Newfoundland; Douglas McMillan, IWK Health Centre, Halifax, Nova Scotia; Andrzej Kajetanowicz, Cape Breton Regional Hospital, Sydney, Nova Scotia; Shoo K. Lee (Chairman, Canadian Neonatal Network), Mount Sinai Hospital, Toronto, Ontario.

^* All authors are on behalf of the Canadian Neonatal Network.

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