Abstract
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.
Keywords
necrotizing enterocolitis - spontaneous intestinal perforation - preterm infant -
feeding - milk fortifier - clinical practice
