Impact of an In-House Pediatric Surgery Unit and Human Milk Centered Enteral Nutrition on Necrotizing Enterocolitis

Abstract EN

The importance for mortality and morbidity of an in-house pediatric surgery unit for premature infants with necrotizing enterocolitis (NEC) remains undefined.

Data on 389 consecutive very low birth weight infants with a birth weight <1250 g admitted between 2009 and 2014 was retrospectively analyzed in two almost identical neonatal intensive care units.

Epidemiological data (n=172 and n=217, respectively) were comparable.

Incidence of NEC stage II+ was significantly higher in center 1 (15.1 versus 5.5%, n=18 versus 6).

This correlated with a significantly lower rate of exclusive human milk feeding compared to center 2 (24.2 versus 59.3%).

Probiotic treatment did not differ.

Importantly, in case of surgery the length of removed intestine (49.9 versus 19.5 cm) and the rate of severe short-bowel syndrome (38.9 versus 0 %) were significantly higher in center 1 (no in-house pediatric surgery).

Furthermore, long-term morbidity assessment revealed more impaired motoric (-4.2 versus -2.2 months, p=0.21) and psychologic (-4.3 versus -1.6 months, p=0.09) development in center 1.

Mortality was similar in both centers.

Conclusions.

Short- and possibly also long-term morbidity of NEC is clearly associated with the presence of an on-site pediatric surgery unit.

Enteral nutrition with human milk seems to be a strong protective factor against NEC.