Aim: Need for Parenteral Nutrition (PN) at 28-days has been shown to be associated with one-year mortality. We investigated the relationship between re-introduction of feeds ≤7 days post decision for laparotomy for NEC, and death or need for PN at 28 days post-decision for surgery.
Methods: A secondary analysis of a prospective dataset (REC:12/SC/0416) of all infants in the UK and Ireland who underwent laparotomy for NEC between 01/03/2013 and 28/02/2014, who survived to re-introduction of feeds. Fourteen infants who restarted enteral feeds after 28 days were excluded. Multivariable logistic regression analysis was used, adjusting for gestational age at birth, small for gestational age (SGA), and disease severity (assessed by need for inotropes at surgery, and operation performed).
Results: 42/144 infants (29%) restarted feeds ≤7 days after decision to intervene surgically, and 102/144 (71%) restarted feeds between 8 and 27 days. Median time (IQR) to restarting feeds was 5.5 (5-6) days and 11 (10-14) days in the two groups. Infants in the ≤7 days group had a higher gestational age at birth (p=0.04), were more likely to be SGA (p=0.007), less likely to require inotropes (p=0.04) and more likely to have undergone resection and primary anastomosis (p<0.001) than those in the >7 days group. Two infants died (5%) and 22 required PN (52%) in the ≤7 days group, and two infants died (2%) and 65 required PN (64%) in the >7 days group. There was no difference between the groups in the rate of death or need for PN at 28 days: OR 0.7(95% CI 0.3-1.6), adjusted OR 0.9(95% CI 0.4-2.2).
We found no evidence of a difference in mortality or PN dependence according to feeding policy.