Delayed initiation but not gradual advancement of enteral formula feeding reduces the incidence of necrotizing enterocolitis (NEC) in preterm pigs

• Published in: PloS one Vol. 9; no. 9; p. e106888
• Main Authors: Ghoneim, Nada, Bauchart-Thevret, Caroline, Oosterloo, Berthe, Stoll, Barbara, Kulkarni, Madhulika, de Pipaon, Miguel Saenz, Zamora, Irving J, Olutoye, Oluyinka O, Berg, Brian, Wittke, Anja, Burrin, Douglas G
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 19.09.2014; Public Library of Science (PLoS)
• Subjects: Agriculture; Animal experimentation; Animals; Biology and Life Sciences; Birth; Enteral feeding; Enteral nutrition; Enteral Nutrition - adverse effects; Enteral Nutrition - methods; Enterocolitis; Enterocolitis, Necrotizing - epidemiology; Enterocolitis, Necrotizing - prevention & control; Feeding; Gastrointestinal diseases; Gene expression; Gene Expression - immunology; Ileum; Ileum - metabolism; Incidence; Infants; Inflammation; Interleukin 6; Intestines - pathology; Jejunum; Medicine and Health Sciences; Necrosis; Necrotizing enterocolitis; Nutrition; Nutrition research; Parenteral nutrition; Parenteral Nutrition, Total - adverse effects; Parenteral Nutrition, Total - methods; Premature Birth; Premature infants; Protein hydrolysates; Risk factors; Rodents; Stomach; Swine; Swine - microbiology; Villus
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0106888

Enteral formula feeding is a risk factor for necrotizing enterocolitis (NEC) in premature infants, yet studies are conflicting regarding the safest timing for introduction and advancement of feeds. Our aim was to test the effects of early vs. late initiation and abrupt vs. gradual advancement of enteral feeding of an intact vs. hydrolyzed protein formula on NEC incidence and severity in preterm pigs. In Experiment 1, preterm pigs received total parenteral nutrition (TPN) at birth with abrupt initiation of enteral formula feeds (50% full intake) on d of life (DOL) 2 (EA) or 5 (LA) while PN continued. Pigs were also fed formula containing either intact or hydrolyzed protein. In Experiment 2, preterm pigs received TPN at birth with enteral, hydrolyzed-protein formula feeds introduced on DOL 2 either abruptly (EA; 50% full feeds) or gradually (EG; 10-50% full feeds over 5 d) while PN continued. NEC incidence and severity were assessed based on macroscopic and histological scoring. In Experiment 1, NEC incidence (41% vs. 70%, P<0.05) and severity were reduced in LA vs. EA groups and LA was associated with a higher survival rate, daily weight gain and jejunum villus height. Piglets fed hydrolyzed vs. intact protein formula had lower stomach content weights and similar NEC incidence. In Experiment 2, NEC incidence and severity were not different between pigs the EG vs. EA group. Proinflammatory gene expression (IL-1β, IL-6 and S100A9) in the ileum was lower in both LA and EG vs. EA groups. In conclusion, delayed initiation but not gradual advancement of enteral feeding is protective against NEC in preterm pigs. Feeding hydrolyzed vs. intact protein formula improved gastric transit without affecting the NEC incidence.