Purpose

To investigate the relationship between timing of re-introduction of feeds following surgery for Necrotising Enterocolitis (NEC) and important early outcomes.

Methods

Secondary analysis of prospectively collected data from paediatric surgical units in UK/Ireland of infants who underwent laparotomy for NEC between 01/03/2013 and 28/02/2014. Multivariable logistic regression analysis was used to compare the relationship of early (≤ 7 days) and later (8–27 days) re-introduction of feeding after surgery on death or need for PN at 28 days, correcting for known cofounders.

Results

41/143 infants (29%) received early and 102/143 infants (71%) had delayed reintroduction of feeding. Infants in the early feeding group had a higher gestational age at birth, higher proportion of growth restriction, lower inotrope requirement, and weremore likely to have undergone primary anastomosis. Following adjustment there was no statistically significant difference detected in the rate of death or need for PN at 28 days, adjusted OR 0.4 (95% CI 0.2–1.1), noting the limited statistical power of this comparison.

Conclusions

There is no evidence from this study to support a minimum period of 7 days nil by mouth post laparotomy for infants with NEC. Early feed reintroduction following laparotomy for NEC is safe in appropriate cases.

Level of evidence

Level II – Treatment Study Group; Prospective comparative study.

中文翻译：

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坏死性小肠结肠炎开腹手术后重新引入肠内营养的时间与短期结果之间的关联

目的

调查坏死性小肠结肠炎 (NEC) 手术后重新引入饲料的时间与重要的早期结果之间的关系。

方法

对 2013 年 1 月 3 日至 2014 年 2 月 28 日期间因 NEC 接受剖腹手术的婴儿的前瞻性收集数据进行二次分析。多变量逻辑回归分析用于比较手术后早期（≤ 7 天）和后期（8-27 天）重新引入喂养对死亡或 28 天需要 PN 的关系，校正已知的共同创始人。

结果

41/143 名婴儿 (29%) 早期接受喂养，102/143 名婴儿 (71%) 延迟重新引入喂养。早期喂养组的婴儿出生时胎龄较高，生长受限比例较高，对正性肌力药的需求较低，并且更容易接受一期吻合。调整后，在 28 天时死亡率或 PN 需求未检测到统计学上的显着差异，调整后的 OR 0.4（95% CI 0.2-1.1），注意到这种比较的统计能力有限。

结论

本研究没有证据支持 NEC 婴儿在剖腹手术后至少 7 天不经口。在适当的情况下，NEC 剖腹手术后早期重新引入饲料是安全的。

证据级别

二级——治疗研究组；前瞻性比较研究。