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Time to Full Enteral Feeds and Late-Onset Sepsis in Extremely Preterm Infants
Ariel A. Salas, Laura Elizabeth Wiener, Marissa Trotta, Vivian Valcarce, Mar Romero‐Lopez, Eric B. Ortigoza, Ting Ting Fu, Kera McNelis, Brenda B. Poindexter, Waldemar A. Carlo, Richard A. Polin, Abbot R. Laptook, Martin Keszler, Angelita M. Hensman, Elisa Vieira, Lucille St. Pierre, Emilee Little, Anna Maria Hibbs, Michele C. Walsh, Deanne E. Wilson-Costello, Nancy S. Newman, Bonnie S. Siner, Angelia Williams, William E. Truog, Howard W. Kilbride, Eugenia K. Pallotto, Prabhu S. Parimi, Cheri Gauldin, Lisa Gaetano, Anne Holmes, Allison Scott, Kurt Schibler, Stephanie L. Merhar, David G. Russell, Cathy Grisby, Kristin Kirker, Julia Thompson, Traci Beiersdorfer, Sandra Wuertz, Juanita Dudley, Lenora Jackson, C. Michael Cotten, Ronald N. Goldberg, Matthew M. Laughon, Joanne Propst, Kimberley A. Fisher, Melissa Babilonia‐Rosa, Carl Bose, Janice Bernhardt, Gennie Bose, Cindy Clark, Jennifer Talbert, Stephen D. Kicklighter, Ginger Rhodes-Ryan, Donna L. White, Ryan Moore, Kelly Bear, Sherry Moseley, Vicki Bergstedt, Joseph Ginski, Wei-li Chang, Juan Guillen Hernandez, Ravi M. Patel, David P. Carlton, Ellen C. Hale, Yvonne Loggins, Colleen Mackie, Diane I. Bottcher, Andrew A. Bremer, Rosemary D. Higgins, Stephanie Wilson Archer, Gregory M. Sokol, Dianne E. Herron, Susan Gunn, Jeffery Joyce, Jon E. Tyson, Kathleen A. Kennedy, Amir Khan, Elizabeth Eason, Emily K. Stephens, Georgia E. McDavid, Donna Hall, Apoorva Mahatme, Karen Martin, Valerie F. Reyna, Debasree Sana Boral, Michelle E. White, Sharon L. Wright, Pablo J. Sánchez, Jonathan L. Slaughter, Leif D. Nelin, Carl H. Backes, Sudarshan R. Jadcherla, Patricia Luzader, Erna Clark, Julie Gutentag, Courtney Park, Julie C. Shadd, Melanie Stein, Margaret Sullivan, Rox Ann Sullivan, Laura Marzec, Kyrstin Warnimont, Demi R. Beckford, Hallie Baugher, Jessica Purnell, Jennifer L. Grothause, Jacqueline McCool, Abhik Das, Kristin M. Zaterka-Baxter, Jenna Gabrio, David LeBlond, Jeanette O’Donnell Auman, Amanda Lewis, Valerie Y. Chock, Krisa P. Van Meurs, David K. Stevenson, Alexis S. Davis, Meera N. Sankar, M. Bethany Ball, Melinda S. Proud, Elizabeth N. Reichert, Dharshi Sivakumar, R. Jordan Williams, Barbara P. Recine, Dona Bahmani, Jennifer E. Chuck, Lilia Rutkowska, Namasivayam Ambalavanan, Monica V. Collins, Shirley S. Cosby, Cindie Buie, Sharon Owen, Tara E. McNair, Kelli P. Hagood, Uday Devaskar, Meena Garg, Teresa Chanlaw, Rachel Geller, Edward F. Bell, Tarah T. Colaizy, Patrick McNamara, Karen Johnson, Mendi L. Schmelzel, Jacky R. Walker, Claire A. Goeke, Sarah E. Faruqui, Brenda J. Coulter, Michelle Baack, Chelsey Elenkiwich, Megan M. Henning, Megan Broadbent, Sarah Van Muyden, Kristi L. Watterberg, Janell Fuller, Robin K. Ohls, Sandra Sundquist Beauman, Conra Backstrom Lacy, Mary Hanson, Elizabeth Kuan, Sara B. DeMauro, Eric C. Eichenwald, Barbara Schmidt, Haresh Kirpalani, Soraya Abbasi, Christine Catts, Aasma S. Chaudhary, Megan A. Dhawan, Sarvin Ghavam, Antoinette Mancini, Jonathan Snyder, Carl T. D’Angio, Ronnie Guillet, Anne Marie Reynolds, Satyan Lakshminrusimha, Holly I.M. Wadkins, Michael G. Sacilowski, Mary Rowan, Rosemary L. Jensen, Diane Prinzing, Ann Marie Scorsone, Kyle Binion, Stephanie Guilford, Constance Orme, Premini Sabaratnam, Daisy Rochez, Alison Kent, Rachel Jones, Elizabeth Boylin, Jennifer Kachelmeyer, Emily Li, Julieanne Hunn, Melissa Bowman, Ashley Williams, Kelsey Voelker, Deanna Maffett, Myra H. Wyckoff, Luc P. Brion, Lijun Chen, Maria M. DeLeon, Joann Duran, Frances Eubanks, M. J. E. Harrod, Lara Pavageau, Pollieanna Sepulveda, Diana M. Vasil, Erick Gerday, Bradley A. Yoder, Mariana Baserga, Stephen D. Minton, Mark J. Sheffield, Carrie A. Rau, Jill Burnett, Susan Christensen, Kathleen Coleman, Brandy Davis, Jennifer O. Elmont, Barbara L. Francom, Jamie Jordan, Manndi C. Loertscher, Trisha Marchant, Earl Maxson, Kandace M. McGrath, Hena G. Mickelsen, Dilys M. Parry, Susan T. Schaefer, Katherine Tice, Kimberlee Weaver-Lewis, Kathryn D. Woodbury, Lisa M. Bell, Rachyl Fisher, Susie Solosth Moody, Seetha Shankaran, Sanjay Chawla, Rebecca Bara, Mary E. Johnson, John Barks, Mary Christensen, Diane F. White, Stephanie A. Wiggins
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Résumé fourni par la source
Importance: Recent studies suggest that early achievement of full enteral feeding improves clinical outcomes among preterm infants. Objective: To examine the association between full enteral feeding and late-onset sepsis. Design, Setting, and Participants: This secondary analysis of a cohort study prospectively followed up a multicenter cohort of preterm infants with gestational ages ranging from 23 to 28 weeks born between January 1, 2012, and December 31, 2021, at 19 US academic centers. Infants without major anomalies who received enteral feedings and survived beyond postnatal day 7 were included. Exposure: Full enteral feeding (≥120 mL/kg/d). Main Outcomes and Measures: The primary outcome was the incidence of late-onset sepsis confirmed through culture-positive results occurring more than 72 hours after birth and treated with antibiotics for 5 or more days. Other clinical outcomes assessed up to 36 weeks of postmenstrual age included necrotizing enterocolitis, death, and growth faltering (weight, length, or head circumference z score decrease >1.2). Risk estimates were adjusted for clinical variables associated with acute critical illness and birth year. Results: Demographic and clinical data from 15 102 preterm infants were analyzed (mean [SD] maternal age, 28.7 [6.1] years; mean [SD] gestational age, 26.0 [1.6] weeks; mean [SD] birth weight, 875 [242] g; 7648 male [50.6%]). Between January 1, 2012, and December 31, 2021, the median (IQR) time to achieve full enteral feeding decreased from 18 (14-28) days to 14 (10-22) days, and the incidence of late-onset sepsis decreased from 21.1% to 16.5% (P = .003). In adjusted analyses, the relative risk of late-onset sepsis per each additional 1-week delay in achieving full enteral feeding was 16% higher (adjusted relative risk [ARR], 1.16; 95% CI, 1.14-1.18; P < .001). Delays in achieving full enteral feeding were also associated with a higher risk of necrotizing enterocolitis (ARR, 1.20; 95% CI, 1.16-1.24; P < .001) and growth faltering in weight (ARR, 1.08; 95% CI, 1.07-1.09), length (ARR, 1.03; 95% CI, 1.02-1.03), and head circumference (ARR, 1.07; 95% CI, 1.06-1.08; P < .001 for all). Conclusions and Relevance: In this cohort study of preterm infants with gestational ages ranging from 23 to 28 weeks who received enteral feeds and survived beyond postnatal day 7, delays in establishing full enteral feeding were associated with a higher risk of late-onset sepsis. These results suggest that early initiation and advancement of enteral feeding have the potential to reduce the risk of late-onset sepsis, growth faltering, and necrotizing enterocolitis.
Sujets associés
Infant Nutrition and HealthClinical Nutrition and GastroenterologyInfant Development and Preterm Care