1. Joy, Subhashni D. Singh

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According to this study:


* Premature infants' need for increased respiratory support and not receiving nutritionally fortified formula or breast milk are predictors of necrotizing enterocolitis.



Many premature infants experience necrotizing enterocolitis (NEC), which is the ischemic death of intestinal tissue. It is among the most common neonatal gastrointestinal emergencies.


In this retrospective study, the medical records of preterm infants at an urban medical center were examined. Eighty-four infants with NEC were each matched with, in most cases, two infants without NEC (n = 163), for a total study population of 247 infants. Of these 247 infants, 93% were born before 32 weeks' gestation and 75% weighed less than 1,250 g at birth. Infants with NEC were an average age of 16 days at diagnosis.


Three factors contributed to NEC development: hypoxia, followed by the need for increased respiratory support, and receiving breast milk or infant formula that wasn't nutritionally fortified. The need for respiratory support increased the odds of developing NEC by 13 times. Receiving breast milk or infant formula that wasn't nutritionally fortified increased the chances of developing NEC by 6 and 4 times, respectively. Infants who required respiratory support and were given breast milk without nutritional fortification had odds of developing NEC that were 29 times greater than those for infants who had neither factor.


Gregory points out that while nutritional fortification of breast milk or formula may offer slight protect against NEC, the effect may be related more to the fact that infants receiving nutritional fortification are already healthy enough to have tolerated early enteral feeding. Thus, the greater incidence of NEC in infants not receiving nutritional fortification may reflect their underlying poor health.


These findings suggest that infants are at highest risk for NEC before they are able to be fed full-volume formula or breast milk with nutritional fortification and after a need develops for increased respiratory support.




Gregory KE. Nurs Res 2008;57(4): 260-70.