A.S.P.E.N. Clinical Guidelines: Nutrition Support of Neonatal Patients at Risk for Necrotizing Enterocolitis

Background: Necrotizing enterocolitis (NEC) is one of the most devastating diseases in the neonatal population, with extremely low birth weight and extremely preterm infants at greatest risk. Method: A systematic review of the best available evidence to answer a series of questions regarding nutriti...

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Published in:JPEN. Journal of parenteral and enteral nutrition 2012-09, Vol.36 (5), p.506-523
Main Authors: Fallon, Erica M., Nehra, Deepika, Potemkin, Alexis K., Gura, Kathleen M., Simpser, Edwin, Compher, Charlene, Puder, Mark, Mirtallo, Jay M., Ayers, Phil, Goday, Praveen S., Ireton-Jones, Carol, Jaksic, Tom, Lyman, Elizabeth M., Malone, Ainsley M., Robinson, Lawrence A., Teitelbaum, Daniel, Van Way, Charles, Boullata, Joseph, Braunschweig, Carol, Druyan, Mary Ellen, George, Donald, Worthington, Patricia
Format: Article
Language:English
Subjects:
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Animals
Arginine - administration & dosage
Biological and medical sciences
Dietary Supplements
Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care
Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition
Enteral Nutrition - methods
Enterocolitis, Necrotizing - therapy
Fatty Acids, Unsaturated - therapeutic use
Glutamine - administration & dosage
Humans
Infant
Infant, Extremely Premature - growth & development
Infant, Low Birth Weight - growth & development
Infant, Newborn
Infant, Premature, Diseases - therapy
Intensive care medicine
Medical sciences
Milk
Milk, Human
Probiotics - therapeutic use
Randomized Controlled Trials as Topic
Risk Factors
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Summary:Background: Necrotizing enterocolitis (NEC) is one of the most devastating diseases in the neonatal population, with extremely low birth weight and extremely preterm infants at greatest risk. Method: A systematic review of the best available evidence to answer a series of questions regarding nutrition support of neonates at risk of NEC was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development and Evaluation working group. A consensus process was used to develop the clinical guideline recommendations prior to external and internal review and approval by the A.S.P.E.N. Board of Directors. Results/Conclusions: (1) When and how should feeds be started in infants at high risk for NEC? We suggest that minimal enteral nutrition be initiated within the first 2 days of life and advanced by 30 mL/kg/d in infants ≥1000g. (Weak) (2) Does the provision of mother’s milk reduce the risk of developing NEC? We suggest the exclusive use of mother’s milk rather than bovine-based products or formula in infants at risk for NEC. (Weak) (3) Do probiotics reduce the risk of developing NEC? There are insufficient data to recommend the use of probiotics in infants at risk for NEC. (Further research needed.) (4) Do nutrients either prevent or predispose to the development of NEC? We do not recommend glutamine supplementation for infants at risk for NEC (Strong). There is insufficient evidence to recommend arginine and/or long chain polyunsaturated fatty acid supplementation for infants at risk for NEC. (Further research needed.) (5) When should feeds be reintroduced to infants with NEC? There are insufficient data to make a recommendation regarding time to reintroduce feedings to infants after NEC. (Further research needed.)
ISSN:0148-6071
1941-2444
DOI:10.1177/0148607112449651