Time to full enteral feeding for very low-birth-weight infants varies markedly among hospitals worldwide but may not be associated with incidence of necrotizing enterocolitis: The NEOMUNE-NeoNutriNet Cohort Study

Marita de Waard, Yanqi Li, Yanna Zhu, Adejumoke I. Ayede, Janet Berrington, Frank H. Bloomfield, Olubunmi O. Busari, Barbara E. Cormack, Nicholas D. Embleton, Johannes B. van Goudoever, Gorm Greisen, Zhongqian He, Yan Huang, Xiaodong Li, Hung Chih Lin, Jiaping Mei, Paula P. Meier, Chuan Nie, Aloka L. Patel, Christian Ritz & 9 others Per T. Sangild, Thomas Skeath, Karen Simmer, Olukemi O. Tongo, Signe S. Uhlenfeldt, Sufen Ye, Xuqiang Ye, Chunyi Zhang, Ping Zhou

Research output: Contribution to journalArticle

Abstract

Background: Transition to enteral feeding is difficult for very low-birth-weight (VLBW; ≤1500 g) infants, and optimal nutrition is important for clinical outcomes. Method: Data on feeding practices and short-term clinical outcomes (growth, necrotizing enterocolitis [NEC], mortality) in VLBW infants were collected from 13 neonatal intensive care units (NICUs) in 5 continents (n = 2947). Specifically, 5 NICUs in Guangdong province in China (GD), mainly using formula feeding and slow feeding advancement (n = 1366), were compared with the remaining NICUs (non-GD, n = 1581, Oceania, Europe, United States, Taiwan, Africa) using mainly human milk with faster advancement rates. Results: Across NICUs, large differences were observed for time to reach full enteral feeding (TFF; 8–33 days), weight gain (5.0–14.6 g/kg/day), ∆z-scores (−0.54 to −1.64), incidence of NEC (1%–13%), and mortality (1%–18%). Adjusted for gestational age, GD units had longer TFF (26 vs 11 days), lower weight gain (8.7 vs 10.9 g/kg/day), and more days on antibiotics (17 vs 11 days; all P <.001) than non-GD units, but NEC incidence and mortality were similar. Conclusion: Feeding practices for VLBW infants vary markedly around the world. Use of formula and long TFF in South China was associated with more use of antibiotics and slower weight gain, but apparently not with more NEC or higher mortality. Both infant- and hospital-related factors influence feeding practices for preterm infants. Multicenter, randomized controlled trials are required to identify the optimal feeding strategy during the first weeks of life.

Original languageEnglish
Pages (from-to)658-667
Number of pages10
JournalJournal of Parenteral and Enteral Nutrition
Volume43
Issue number5
DOIs
Publication statusPublished - 1 Jul 2019

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Necrotizing Enterocolitis
Very Low Birth Weight Infant
Neonatal Intensive Care Units
Enteral Nutrition
Cohort Studies
Weight Gain
Intensive care units
Mortality
Incidence
China
Oceania
Anti-Bacterial Agents
Human Milk
Antibiotics
Taiwan
Premature Infants
Gestational Age
Randomized Controlled Trials
Nutrition
Growth

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de Waard, Marita ; Li, Yanqi ; Zhu, Yanna ; Ayede, Adejumoke I. ; Berrington, Janet ; Bloomfield, Frank H. ; Busari, Olubunmi O. ; Cormack, Barbara E. ; Embleton, Nicholas D. ; van Goudoever, Johannes B. ; Greisen, Gorm ; He, Zhongqian ; Huang, Yan ; Li, Xiaodong ; Lin, Hung Chih ; Mei, Jiaping ; Meier, Paula P. ; Nie, Chuan ; Patel, Aloka L. ; Ritz, Christian ; Sangild, Per T. ; Skeath, Thomas ; Simmer, Karen ; Tongo, Olukemi O. ; Uhlenfeldt, Signe S. ; Ye, Sufen ; Ye, Xuqiang ; Zhang, Chunyi ; Zhou, Ping. / Time to full enteral feeding for very low-birth-weight infants varies markedly among hospitals worldwide but may not be associated with incidence of necrotizing enterocolitis : The NEOMUNE-NeoNutriNet Cohort Study. In: Journal of Parenteral and Enteral Nutrition. 2019 ; Vol. 43, No. 5. pp. 658-667.
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abstract = "Background: Transition to enteral feeding is difficult for very low-birth-weight (VLBW; ≤1500 g) infants, and optimal nutrition is important for clinical outcomes. Method: Data on feeding practices and short-term clinical outcomes (growth, necrotizing enterocolitis [NEC], mortality) in VLBW infants were collected from 13 neonatal intensive care units (NICUs) in 5 continents (n = 2947). Specifically, 5 NICUs in Guangdong province in China (GD), mainly using formula feeding and slow feeding advancement (n = 1366), were compared with the remaining NICUs (non-GD, n = 1581, Oceania, Europe, United States, Taiwan, Africa) using mainly human milk with faster advancement rates. Results: Across NICUs, large differences were observed for time to reach full enteral feeding (TFF; 8–33 days), weight gain (5.0–14.6 g/kg/day), ∆z-scores (−0.54 to −1.64), incidence of NEC (1{\%}–13{\%}), and mortality (1{\%}–18{\%}). Adjusted for gestational age, GD units had longer TFF (26 vs 11 days), lower weight gain (8.7 vs 10.9 g/kg/day), and more days on antibiotics (17 vs 11 days; all P <.001) than non-GD units, but NEC incidence and mortality were similar. Conclusion: Feeding practices for VLBW infants vary markedly around the world. Use of formula and long TFF in South China was associated with more use of antibiotics and slower weight gain, but apparently not with more NEC or higher mortality. Both infant- and hospital-related factors influence feeding practices for preterm infants. Multicenter, randomized controlled trials are required to identify the optimal feeding strategy during the first weeks of life.",
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author = "{de Waard}, Marita and Yanqi Li and Yanna Zhu and Ayede, {Adejumoke I.} and Janet Berrington and Bloomfield, {Frank H.} and Busari, {Olubunmi O.} and Cormack, {Barbara E.} and Embleton, {Nicholas D.} and {van Goudoever}, {Johannes B.} and Gorm Greisen and Zhongqian He and Yan Huang and Xiaodong Li and Lin, {Hung Chih} and Jiaping Mei and Meier, {Paula P.} and Chuan Nie and Patel, {Aloka L.} and Christian Ritz and Sangild, {Per T.} and Thomas Skeath and Karen Simmer and Tongo, {Olukemi O.} and Uhlenfeldt, {Signe S.} and Sufen Ye and Xuqiang Ye and Chunyi Zhang and Ping Zhou",
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de Waard, M, Li, Y, Zhu, Y, Ayede, AI, Berrington, J, Bloomfield, FH, Busari, OO, Cormack, BE, Embleton, ND, van Goudoever, JB, Greisen, G, He, Z, Huang, Y, Li, X, Lin, HC, Mei, J, Meier, PP, Nie, C, Patel, AL, Ritz, C, Sangild, PT, Skeath, T, Simmer, K, Tongo, OO, Uhlenfeldt, SS, Ye, S, Ye, X, Zhang, C & Zhou, P 2019, 'Time to full enteral feeding for very low-birth-weight infants varies markedly among hospitals worldwide but may not be associated with incidence of necrotizing enterocolitis: The NEOMUNE-NeoNutriNet Cohort Study' Journal of Parenteral and Enteral Nutrition, vol. 43, no. 5, pp. 658-667. https://doi.org/10.1002/jpen.1466

Time to full enteral feeding for very low-birth-weight infants varies markedly among hospitals worldwide but may not be associated with incidence of necrotizing enterocolitis : The NEOMUNE-NeoNutriNet Cohort Study. / de Waard, Marita; Li, Yanqi; Zhu, Yanna; Ayede, Adejumoke I.; Berrington, Janet; Bloomfield, Frank H.; Busari, Olubunmi O.; Cormack, Barbara E.; Embleton, Nicholas D.; van Goudoever, Johannes B.; Greisen, Gorm; He, Zhongqian; Huang, Yan; Li, Xiaodong; Lin, Hung Chih; Mei, Jiaping; Meier, Paula P.; Nie, Chuan; Patel, Aloka L.; Ritz, Christian; Sangild, Per T.; Skeath, Thomas; Simmer, Karen; Tongo, Olukemi O.; Uhlenfeldt, Signe S.; Ye, Sufen; Ye, Xuqiang; Zhang, Chunyi; Zhou, Ping.

In: Journal of Parenteral and Enteral Nutrition, Vol. 43, No. 5, 01.07.2019, p. 658-667.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Time to full enteral feeding for very low-birth-weight infants varies markedly among hospitals worldwide but may not be associated with incidence of necrotizing enterocolitis

T2 - The NEOMUNE-NeoNutriNet Cohort Study

AU - de Waard, Marita

AU - Li, Yanqi

AU - Zhu, Yanna

AU - Ayede, Adejumoke I.

AU - Berrington, Janet

AU - Bloomfield, Frank H.

AU - Busari, Olubunmi O.

AU - Cormack, Barbara E.

AU - Embleton, Nicholas D.

AU - van Goudoever, Johannes B.

AU - Greisen, Gorm

AU - He, Zhongqian

AU - Huang, Yan

AU - Li, Xiaodong

AU - Lin, Hung Chih

AU - Mei, Jiaping

AU - Meier, Paula P.

AU - Nie, Chuan

AU - Patel, Aloka L.

AU - Ritz, Christian

AU - Sangild, Per T.

AU - Skeath, Thomas

AU - Simmer, Karen

AU - Tongo, Olukemi O.

AU - Uhlenfeldt, Signe S.

AU - Ye, Sufen

AU - Ye, Xuqiang

AU - Zhang, Chunyi

AU - Zhou, Ping

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Background: Transition to enteral feeding is difficult for very low-birth-weight (VLBW; ≤1500 g) infants, and optimal nutrition is important for clinical outcomes. Method: Data on feeding practices and short-term clinical outcomes (growth, necrotizing enterocolitis [NEC], mortality) in VLBW infants were collected from 13 neonatal intensive care units (NICUs) in 5 continents (n = 2947). Specifically, 5 NICUs in Guangdong province in China (GD), mainly using formula feeding and slow feeding advancement (n = 1366), were compared with the remaining NICUs (non-GD, n = 1581, Oceania, Europe, United States, Taiwan, Africa) using mainly human milk with faster advancement rates. Results: Across NICUs, large differences were observed for time to reach full enteral feeding (TFF; 8–33 days), weight gain (5.0–14.6 g/kg/day), ∆z-scores (−0.54 to −1.64), incidence of NEC (1%–13%), and mortality (1%–18%). Adjusted for gestational age, GD units had longer TFF (26 vs 11 days), lower weight gain (8.7 vs 10.9 g/kg/day), and more days on antibiotics (17 vs 11 days; all P <.001) than non-GD units, but NEC incidence and mortality were similar. Conclusion: Feeding practices for VLBW infants vary markedly around the world. Use of formula and long TFF in South China was associated with more use of antibiotics and slower weight gain, but apparently not with more NEC or higher mortality. Both infant- and hospital-related factors influence feeding practices for preterm infants. Multicenter, randomized controlled trials are required to identify the optimal feeding strategy during the first weeks of life.

AB - Background: Transition to enteral feeding is difficult for very low-birth-weight (VLBW; ≤1500 g) infants, and optimal nutrition is important for clinical outcomes. Method: Data on feeding practices and short-term clinical outcomes (growth, necrotizing enterocolitis [NEC], mortality) in VLBW infants were collected from 13 neonatal intensive care units (NICUs) in 5 continents (n = 2947). Specifically, 5 NICUs in Guangdong province in China (GD), mainly using formula feeding and slow feeding advancement (n = 1366), were compared with the remaining NICUs (non-GD, n = 1581, Oceania, Europe, United States, Taiwan, Africa) using mainly human milk with faster advancement rates. Results: Across NICUs, large differences were observed for time to reach full enteral feeding (TFF; 8–33 days), weight gain (5.0–14.6 g/kg/day), ∆z-scores (−0.54 to −1.64), incidence of NEC (1%–13%), and mortality (1%–18%). Adjusted for gestational age, GD units had longer TFF (26 vs 11 days), lower weight gain (8.7 vs 10.9 g/kg/day), and more days on antibiotics (17 vs 11 days; all P <.001) than non-GD units, but NEC incidence and mortality were similar. Conclusion: Feeding practices for VLBW infants vary markedly around the world. Use of formula and long TFF in South China was associated with more use of antibiotics and slower weight gain, but apparently not with more NEC or higher mortality. Both infant- and hospital-related factors influence feeding practices for preterm infants. Multicenter, randomized controlled trials are required to identify the optimal feeding strategy during the first weeks of life.

KW - antibiotics

KW - formula

KW - growth

KW - milk

KW - NEC

KW - parenteral

KW - preterm infants

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U2 - 10.1002/jpen.1466

DO - 10.1002/jpen.1466

M3 - Article

VL - 43

SP - 658

EP - 667

JO - Journal of Patenteral and Enternal Nutrition

JF - Journal of Patenteral and Enternal Nutrition

SN - 0148-6071

IS - 5

ER -