Aggressive feeding of premature infants doesn't increase bowel disease risk
Swedish hospitals have safely adopted more aggressive feeding protocols for extremely premature infants without triggering higher rates of necrotising enterocolitis, a life-threatening gut condition. The finding challenges long-standing caution about feeding tiny infants and could reshape neonatal nutrition guidelines across healthcare systems.
Originaltitel: Early enteral nutrition practices and their association with growth and necrotising enterocolitis in extremely preterm infants—A dual national cohort study
Abstract Background In Sweden, the incidence of necrotising enterocolitis (NEC) in extremely preterm infants has increased from 6 to 10% over a decade. We examined whether changes in enteral nutrition during the first 2 weeks were associated with growth and development of NEC. Methods The EXPRESS (2004–2007) and EXPRESS 2 (2014–2016) cohorts included infants <27 gestational weeks. NEC diagnoses were validated. Nutritional data were retrieved from four of the six healthcare regions ( n = 815). Growth and NEC incidence were compared between cohorts, and odds ratios (OR) were adjusted for early risk factors in a logistic regression model. Results In EXPRESS 2, during the first postnatal week, feeding advancement was more rapid (10 vs. 8 ml/kg/d, p < 0.001) and fortification more common (27% vs. 3.6%, p < 0.001). Growth improved from birth to 28 days (delta z -scores: weight, –2.18 vs. –1.49, p < 0.001; length, –2.22 vs. –1.96, p = 0.013) and to 36 weeks’ postmenstrual age. Neither feeding advancement nor fortification was associated with increased NEC risk >7 d ( n = 44; aOR 0.96, 95% CI 0.91–1.01, p = 0.15; aOR 1.33, 95% CI 0.57–2.79, p = 0.50). Conclusion A more active early enteral nutrition policy in Sweden was associated with faster feeding advancement, earlier fortification, increased protein intake, and improved growth without increased NEC risk. Impact Human breastmilk fortification increased, and macronutrient intakes improved among extremely preterm infants in Sweden during the years 2014–2016, compared to 2004–2007. Weight and length growth improved during the years 2014–2016. More active enteral nutrition during 2014–2016 was not associated with an increased incidence of necrotising enterocolitis. The study uses validated, population-based data from two national cohorts with high-resolution daily nutrition and growth records. Findings support earlier feeding advancement and fortification to improve growth without increasing necrotising enterocolitis risk in extremely preterm infants.