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Enteral Feed Exposures in Babies Born Less Than 32 Weeks: On Behalf of the UK Neonatal Collaborative Necrotising Enterocolitis (UKNC-NEC) Study Group

Presented at the Neonatal Society 2013 Autumn Meeting.

Battersby C1, Santhakumaran S, Fitz-Simon N, Modi N on behalf of the UKNC-NEC Study Group

Imperial College London, Neonatal Data Analysis Unit (NDAU)

Background: Feeding strategies are widely believed to influence the susceptibility of preterm babies to NEC. However, due to the limited evidence available to inform optimal feeding strategies, there is variation in feeding practices (1). Feeding information is entered on a daily basis by the UKNC-NEC study group, comprised of neonatal teams committed to entering high quality routinely collected data for the UKNC-NEC study. We hypothesise that due to the increased risk of NEC, babies of younger gestational ages are fed more cautiously; they are less likely to receive formula and commencement of feeds is delayed compared to more mature babies. In addition, we describe the use of donor milk across neonatal units in England. 

Methods: 26 variables from babies born between 23 and 31+6 weeks and first admitted in year 2012 to 146 neonatal units in the UKNC-NEC study group was extracted from the National Neonatal Research Database. For babies who were fed during neonatal care, the median and interquartile range for days to first feed by gestational age is reported. A flexible competing risks model was used to model the cumulative incidence of commencement of enteral feeds and formula, taking into account a time-dependent effect of gestation. The mean and interquartile ranges for proportion of care days using donor milk across 146 units is reported. The study is funded by Medicines for Neonates Programme and received research ethics approval (11/LO/1430). 

Results: The final analysis included 6641 babies born between 23 and 31+6 weeks and first admitted in year 2012 to 146 neonatal units. Daily type of feed was well completed (98%) compared to daily volume (59%). For 6347 babies who were fed, the median and interquartile (IQ) range of days to first feed was 4 (3-6) for babies born 24 weeks and 2 (2-3) for babies born 30 weeks. There was a statistically significant effect of gestation on time to first feed and time to formula (p<0.0001 from likelihood ratio test comparing models with and without gestational age terms), with younger babies receiving first feed and formula later and the effect of gestation reducing over time. The median (IQ range) of percentage of care days when donor milk is given is 1.8 (0.3-5.8).

Conclusion: The time to first feed and introduction of formula is inversely related to gestational age; there is more variation in time to first feed amongst babies of younger gestational ages. Preliminary analyses suggest that the use of donor milk may vary even amongst units providing the same level of care. These variations may be explained by the uncertainties of optimal feeding strategies to prevent NEC and differences in availability of donor milk.

Corresponding author: c.battersby@imperial.ac.uk

1. Klingenberg, C., et al., Enteral feeding practices in very preterm infants: an international survey. Archives of Disease in Childhood – Fetal and Neonatal Edition, 2012. 97(1): p. F56-F61

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