Amer J Perinatol
DOI: 10.1055/s-0037-1608928
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Temporal Relationship of Onset of Necrotizing Enterocolitis and Introduction of Enteric Feedings and Powdered Milk Fortifier

Yana Vaks1, Krista L. Birnie2, Suzan L. Carmichael2, Tina Hernandez-Boussard3, William E. Benitz2
  • 1Department of Pediatric Critical Care, Kaiser Permanente Medical Center, Santa Clara, California
  • 2Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
  • 3Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, California
Further Information

Publication History

25 September 2017

31 October 2017

Publication Date:
30 November 2017 (eFirst)


Objective This article evaluates temporal relationships between onset of necrotizing enterocolitis (NEC) in preterm infants and introduction of enteral feedings or powdered human milk fortifier (HMF).

Study Design This is a Poisson regression analysis of NEC cases at a single children's hospital between 1999 and 2009, using the self-controlled case series method to estimate adjusted daily event rate ratios (DERR) during postexposure intervals.

Results Of 139 patients with a clinical diagnosis of NEC, 26 had early disease onset prior to initiation of feeding and were considered to be cases of spontaneous intestinal perforation (SIP). For the remaining 113 infants, the DERR for NEC onset were significantly greater on days for which infants were <14 days of age (DERR, 2.15; 95% confidence interval [CI], 1.22–3.79) or ≥31 weeks postmenstrual age (2.94; 95% CI, 1.51–5.83) or which fell within 14 days after initiation of enteric feeding (8.29; 95% CI, 4.73–14.53) or 4 days after introduction of HMF (12.32; 95% CI, 7.13–21.29).

Conclusion There are strong temporal associations between onset of NEC and initiation of enteral feeding or powdered HMF in preterm infants.