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Enteral feeding regimens and necrotising enterocolitis in preterm infants: a multicentre case–control study
  1. G Henderson1,
  2. S Craig2,
  3. P Brocklehurst3,
  4. W McGuire4
  1. 1
    Griffith University, Brisbane, Australia
  2. 2
    Royal Jubilee Maternity Hospital, Belfast, Northern Ireland, UK
  3. 3
    National Perinatal Epidemiology Unit, Oxford, UK
  4. 4
    Australian National University, Canberra, Australia
  1. W McGuire, Centre for Newborn Care, The Canberra Hospital, ACT 2606, Australia; william.mcguire{at}


Background: Most preterm infants who develop necrotising enterocolitis (NEC) have received enteral feeds. Uncertainty exists about which aspects of the feeding regimen affect the risk of NEC.

Aim: To examine associations between various enteral feeding practices and the development of NEC in preterm infants.

Methods: Multicentre case–control study. 53 preterm infants with NEC were enrolled together with a gestational age frequency-matched control without NEC from a randomly selected neonatal unit. Clinical and feeding data were extracted and compared between the groups.

Results: Significantly fewer cases than controls had received human breast milk (75% vs 91%; OR 0.32, 95% CI 0.11 to 0.98). The day on which enteral feeding was started did not differ significantly (mean (SD) days after birth: cases 2.9 (2.8) and controls 2.8 (1.8)). The mean (SD) duration of trophic feeding (<1 ml/kg/h) was significantly shorter in the cases (3.3 (3.1) days) than controls (6.2 (6.7) days) (mean difference (MD) −2.9, 95% CI −4.9 to −0.9) days. Cases were fully fed significantly earlier than controls (mean (SD) days after birth: cases 9.9 (4.2) and controls 14.3 (9.8); MD −4.4, 95% CI −7.3 to −1.5).

Conclusions: These data suggest that the duration of trophic feeding and rate of advancement of feed volumes may be modifiable risk factors for NEC in preterm infants. Further randomised controlled trials are warranted to assess the effect of different rates of feed advancement on the incidence of NEC, as well as other outcomes.

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  • Funding: The study was funded by Tenovus (Scotland). The funder had no role in the collection, analysis and interpretation of data, or in the writing of the report and the decision to submit the paper for publication. The National Perinatal Epidemiology Unit receives funding from the Department of Health. The views expressed in this publication are those of the authors and not necessarily those of the Department of Health.

  • Competing interests: None.

  • Ethics approval: The Northern and Yorkshire multicentre research ethics committee approved the study.

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