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Arch Dis Child Fetal Neonatal Ed. 2005 Mar; 90(2): F147–F151.
PMCID: PMC1721845

Impact of standardised feeding regimens on incidence of neonatal necrotising enterocolitis: a systematic review and meta-analysis of observational studies


Background: A significant and prolonged decline in the incidence of necrotising enterocolitis (NEC), nearing virtual elimination in some centres, has been observed consistently since implementation of a standardised feeding regimen.

Aim: To systematically review the observational studies reporting incidence of NEC in preterm, low birth weight (LBW) neonates "before" and "after" implementation of a standardised feeding regimen.

Methods: The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2002), Medline, Embase, Cinahl, and proceedings of the Pediatric Academic Societies (published in Pediatric Research from 1980) were searched in July and again in October 2003. The reference lists of identified observational studies, and personal files, were searched. No language restriction was applied. Key words were: standardised, enteral, feeding, neonates, necrotising enterocolitis. Authors were contacted for clarification of data.

Results: Six eligible studies (1978–2003) were identified. A significant heterogeneity was noted between the studies indicating the variations in the population characteristics and feeding practices over a period of 25 years. Meta-analysis of the six studies using a random effects model revealed a pooled risk ratio of 0.13 (95% confidence interval 0.03 to 0.50)—that is, introduction of a standardised feeding regimen reduced the incidence of NEC by 87%.

Conclusion: Standardised feeding regimens may provide the single most important global tool to prevent/minimise NEC in preterm neonates. Randomised controlled trials are needed.

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Selected References

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  • Kosloske AM. Epidemiology of necrotizing enterocolitis. Acta Paediatr Suppl. 1994;396:2–7. [PubMed]
  • Llanos Adolfo R, Moss Mark E, Pinzòn Maria C, Dye Timothy, Sinkin Robert A, Kendig James W. Epidemiology of neonatal necrotising enterocolitis: a population-based study. Paediatr Perinat Epidemiol. 2002 Oct;16(4):342–349. [PubMed]
  • Uauy RD, Fanaroff AA, Korones SB, Phillips EA, Phillips JB, Wright LL. Necrotizing enterocolitis in very low birth weight infants: biodemographic and clinical correlates. National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr. 1991 Oct;119(4):630–638. [PubMed]
  • Brown EG, Sweet AY. Preventing necrotizing enterocolitis in neonates. JAMA. 1978 Nov 24;240(22):2452–2454. [PubMed]
  • Spritzer R, Koolen AM, Baerts W, Fetter WP, Lafeber HN, Sauer PJ. A prolonged decline in the incidence of necrotizing enterocolitis after the introduction of a cautious feeding regimen. Acta Paediatr Scand. 1988 Nov;77(6):909–911. [PubMed]
  • Kamitsuka MD, Horton MK, Williams MA. The incidence of necrotizing enterocolitis after introducing standardized feeding schedules for infants between 1250 and 2500 grams and less than 35 weeks of gestation. Pediatrics. 2000 Feb;105(2):379–384. [PubMed]
  • Patole S, McGlone L, Muller R. Virtual elimination of necrotising enterocolitis for 5 years - reasons? Med Hypotheses. 2003 Nov-Dec;61(5-6):617–622. [PubMed]
  • Patole SK, Kadalraja R, Tuladhar R, Almonte R, Muller R, Whitehall JS. Benefits of a standardised feeding regimen during a clinical trial in preterm neonates. Int J Clin Pract. 2000 Sep;54(7):429–431. [PubMed]
  • Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, Brotherton T. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978 Jan;187(1):1–7. [PMC free article] [PubMed]
  • Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986 Feb;33(1):179–201. [PubMed]
  • Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000 Apr 19;283(15):2008–2012. [PubMed]
  • Premji Shahirose S, Chessell Lorraine, Paes Bosco, Pinelli Janet, Jacobson Kevan. A matched cohort study of feeding practice guidelines for infants weighing less than 1,500 g. Adv Neonatal Care. 2002 Feb;2(1):27–36. [PubMed]
  • Kuzma-O'Reilly Barbara, Duenas Maria L, Greecher Coleen, Kimberlin Lois, Mujsce Dennis, Miller Debra, Walker Donna Jean. Evaluation, development, and implementation of potentially better practices in neonatal intensive care nutrition. Pediatrics. 2003 Apr;111(4 Pt 2):e461–e470. [PubMed]
  • Patole SK, Almonte R, Kadalraja R, Tuladhar R, Muller R, Whitehall JS. Can prophylactic oral erythromycin reduce time to full enteral feeds in preterm neonates? Int J Clin Pract. 2000 Oct;54(8):504–508. [PubMed]
  • Kilbride Howard W, Wirtschafter David D, Powers Richard J, Sheehan Michael B. Implementation of evidence-based potentially better practices to decrease nosocomial infections. Pediatrics. 2003 Apr;111(4 Pt 2):e519–e533. [PubMed]
  • Merritt TA, Palmer D, Bergman DA, Shiono PH. Clinical practice guidelines in pediatric and newborn medicine: implications for their use in practice. Pediatrics. 1997 Jan;99(1):100–114. [PubMed]
  • Halac E, Halac J, Bégué EF, Casañas JM, Indiveri DR, Petit JF, Figueroa MJ, Olmas JM, Rodríguez LA, Obregón RJ, et al. Prenatal and postnatal corticosteroid therapy to prevent neonatal necrotizing enterocolitis: a controlled trial. J Pediatr. 1990 Jul;117(1 Pt 1):132–138. [PubMed]
  • Precioso Alexander Roberto, Proenca Renata Suman Mascaretti. Necrotizing enterocolitis, pathogenesis and the protector effect of prenatal corticosteroids. Rev Hosp Clin Fac Med Sao Paulo. 2002 Sep-Oct;57(5):243–248. [PubMed]
  • Shulman RJ, Schanler RJ, Lau C, Heitkemper M, Ou CN, Smith EO. Early feeding, antenatal glucocorticoids, and human milk decrease intestinal permeability in preterm infants. Pediatr Res. 1998 Oct;44(4):519–523. [PubMed]
  • Furman Lydia, Taylor Gerry, Minich Nori, Hack Maureen. The effect of maternal milk on neonatal morbidity of very low-birth-weight infants. Arch Pediatr Adolesc Med. 2003 Jan;157(1):66–71. [PubMed]
  • Arnold Lois D W. The cost-effectiveness of using banked donor milk in the neonatal intensive care unit: prevention of necrotizing enterocolitis. J Hum Lact. 2002 May;18(2):172–177. [PubMed]
  • Caplan Michael S, Amer Michael, Jilling Tamas. The role of human milk in necrotizing enterocolitis. Adv Exp Med Biol. 2002;503:83–90. [PubMed]
  • Kelleher SL, Lönnerdal B. Immunological activities associated with milk. Adv Nutr Res. 2001;10:39–65. [PubMed]
  • Kosloske AM. Breast milk decreases the risk of neonatal necrotizing enterocolitis. Adv Nutr Res. 2001;10:123–137. [PubMed]
  • Goldman AS. Modulation of the gastrointestinal tract of infants by human milk. Interfaces and interactions. An evolutionary perspective. J Nutr. 2000 Feb;130(2S):426S–431S. [PubMed]

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