434 - Current Trends in Time to Full Enteral Feeding, Late-onset Sepsis, Necrotizing Enterocolitis, and Growth Outcomes of Infants Born Extremely Preterm

Poster Number: 434
Publication Number: 434.1855

Background: Recent studies, including meta-analyses of randomized trials, suggest that early achievement of full enteral feeding improves clinical outcomes among extremely preterm (EPT) infants.

Objective: The primary objective of this study was to examine the association between the time required to achieve full enteral feeding and late-onset sepsis (LOS) in EPT infants admitted to Neonatal Research Network centers between 2012 and 2021.

Design/Methods: In this secondary analysis of a prospectively followed multicenter cohort of EPT infants born 23 to 28 weeks of gestation, infants without major congenital or chromosomal anomalies who received enteral feedings and survived beyond postnatal day 7 were included. The exposure variable of interest was the time to achieve full enteral feeding (120 ml/kg/day or more). The primary efficacy outcome was the incidence of LOS confirmed through culture-positive results and occurring after 72 hours postnatally. Other clinical outcomes assessed at 36 weeks of postmenstrual age (PMA) included necrotizing enterocolitis (NEC); death; and weight, length, and head circumference growth faltering defined as change in Fenton growth curve z-score <-1.2. Risk estimates were adjusted with robust Poisson regression models that included center, birth year, 5-minute Apgar score, small for gestational age status, maternal characteristics, probability of survival to 36 weeks’ PMA without bronchopulmonary dysplasia (BPD) at birth estimated using the Neonatal BPD Outcome Estimator (a surrogate of severity of critical illness at birth), and change in the probability of survival to 36 weeks’ PMA without BPD from birth to postnatal day 7.

Results: Data from 15,102 EPT infants were analyzed (Table 1). The median days to achieve full enteral feeding was 18 in 2012 (IQR: 14 – 28) and 14 in 2021 (IQR: 10 – 22). The percent of infants who achieved full enteral feeding within the first 10 days after birth increased from 6% in 2012 to 25% in 2021 (Figure 1). Over the same time frame, the incidence of LOS decreased by 4.6%. In infants who achieved full enteral feeding by 36 weeks PMA (n=14,056), the risk of LOS significantly increased for each additional 1-week delay in achieving full enteral feeding (aRR: 1.16; 95% CI: 1.14 – 1.18; p< 0.0001). Risk estimates for the association between full enteral feeding and other clinical outcomes are shown in Table 2.

Conclusion(s): The practice of establishing full enteral feeding within the first 10 after birth has increased over time and occurs in one quarter of EPT infants. Delays in establishing full enteral feeding are associated with a higher risk of LOS.