Reducing Incidence of Necrotizing Enterocolitis

Own mother's milk (OMM) is associated with reduced odds of necrotizing enterocolitis (NEC) in observational studies, and quality improvement (QI) efforts to increase OMM have been successful at decreasing NEC. Donor milk (DM) has also been associated with NEC reduction when OMM is unavailable, although DM has not been associated with other health benefits as seen with OMM feedings in preterm infants. Institution of standardized feeding guidelines has been associated with reduced NEC rates, although the optimal rates of advancement and fortification are uncertain. Prolonged periods of nothing by mouth are associated with increased rates and severity of NEC and thus enteral feedings should be instituted soon after birth. Acid antagonists and prolonged empiric antibiotics in the setting of negative cultures are associated with increased odds of NEC, and both should be minimized or avoided if possible. Probiotics have been associated with reduced NEC in some, but not all, studies. Meta analyses demonstrate reduction in NEC. At,present, however, there remains controversy about probiotics due to concerns regarding quality and reliability of available products. Anemia and blood transfusions have been linked to NEC. Controversy remains regarding these relationships and best practices regarding enteral feeding during blood transfusions.