Management of Enteral Feeding and Application of Probiotics in Very Low Birth Weight Infants – A National Survey in German NICUs

Abstract

Background The advantage of breast milk feeding, and supplementation of probiotics is well known and proven. However, the lack of reliable amounts of colostrum and/or transient breast milk during the first few postnatal days might inhibit timely enteral nutrition.

Methods The aim of this nationwide survey in German Level-1 neonatal intensive care units (NICUs) was to collect data regarding the management of feeding in the first days of life in very low birth weight infants (VLBWIs, birth weight<1500 g). In addition, we analyzed differences in the use of probiotics. An online survey was sent to all 163 Level-1 NICUs in Germany.

Results 110/163 (67.5%) hospitals participated in our study. One-fifth of all participants used exclusively breast milk. The reported incidence of necrotizing enterocolitis (NEC) was lower in NICUs that exclusively used breast milk in VLBWIs (p=0.08). Two-thirds start enteral feeding independent of gestational age during the first 12 hours postnatally with either breast milk or formula. 80% of all participants checked gastric residuals routinely. The use of probiotics differs widely concerning duration and interruption during antibiotic therapy.

Conclusion The exclusive use of breast milk is associated with a lower incidence of NEC. The result of our survey emphasizes the paramount importance of nutrition with mother`s milk. In case of insufficient availability of mother`s milk, the use of human donor milk still appears to be superior to formula feeding. The implementation of human donor milk banks should therefore be promoted.

Zusammenfassung

Einleitung Im Leben von Frühgeboren (Geburtsgewicht<1500 g) spielen die ersten Lebenstage eine entscheidende Rolle für einen unkomplizierten Verlauf und eine gute Entwicklungsprognose. Insbesondere in den ersten postnatalen Tagen mangelt es jedoch an mütterlichem Kolostrum oder Muttermilch, was einem frühen enteralen Nahrungsaufbau entgegensteht. Aus diesem Grund ist die Verwendung von Formula-Nahrung immer noch weit verbreitet.

Methodik Um das Vorgehen beim Nahrungsaufbau sowie die Applikation von Probiotika zu analysieren, wurde im Sommer 2020 an alle 163 Level-1 Zentren in Deutschland ein online-Umfragebogen versandt.

Ergebnisse Insgesamt nahmen 110 (67,5%) Zentren an der Umfrage teil. 1/5 gaben an, ausschließlich Muttermilch zu verwenden. Die Inzidenz der Nekrotisierenden Enterokolitis (NEC) war bei diesen Zentren geringer (p=0.08). 2/3 erklärten, unabhängig vom Gestationsalter innerhalb der ersten 12 Stunden die enterale Ernährung entweder mit Muttermilch (inkl. Spendermilch) oder Formulanahrung zu beginnen. 80% aller Zentren prüft routinemäßig Magenreste vor der nächsten Mahlzeit. Die Applikation von Probiotika hinsichtlich Dauer oder der Fortführung während einer antibiotischen Therapie variierte erheblich.

Zusammenfassung Die ausschließliche Verwendung von Frauenmilch geht mit einer geringeren NEC-Inzidenz einher. Die Ergebnisse dieser Umfrage unterstreichen damit die Bedeutung von Muttermilchernährung. Im Falle von fehlender mütterlicher Milch erscheint die Verwendung von Ammenmilch der Ernährung mit Formulanahrung überlegen. Der Aufbau von Muttermilchbanken sollte unterstützt werden.

Key words

preterm infants - enteral feeding - probiotics

Schlüsselwörter

Nahrungsaufbau - Frühgeburtlichkeit - Probiotika Gabe

Publication History

Received: 03 May 2022

Accepted after revision: 23 August 2022

Article published online:
10 October 2022

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