Mother milk use in the perioperative period, is there an association with NEC? A retrospective cohort study.

Abstract

Background Patients with a congenital heart disease (CHD) are at high risk for developing necrotizing enterocolitis (NEC) due to the decreased perfusion to the intestines. To limit the risk of NEC, nutrition, and specific mother milk, is an important factor. Due to its many benefits for the neonate. Therefore, we investigated if there is any association between mother milk and the risk of developing NEC in patients with a CHD.

Method A retrospective cohort study was performed of all newborns admitted to the Pediatric Intensive Care Unit (PICU) and the high care cardiology ward of the Wilhelmina Children’s Hospital (WKZ) between 2017 and 2022 with a congenital heart disease (CHD) and who needed a heart surgery within the first 6 weeks of life. Nutritional information and relevant covariates were collected. Patients were divided in two cohorts based on the development of NEC. The cohorts were analyzed using different statistic tests.

Results 270 patients met the inclusion criteria, 36 developed NEC. The mean value (ml/kg/day) in patients with NEC was lower than in patients without NEC. There was a significant difference in feeding type between the patients with and without NEC in the period postnatal, and overall (p= 0.0352 respectively p= 0.0058). The periods post first surgery and post second surgery did not show any significant difference (p= 0.5991 respectively p= 0.0863). After pairwise comparing a significant difference was seen between only formula and a combination in the overall period (OR 2.69 95% CI 1.20-6.38, p=0.019). And a significance difference was seen between only formula and a combination in the postnatal period (OR 13.82 95% CI 2.31-146.4, p=0.00).

Conclusion Patients with NEC are more likely to be formula fed. And patients with NEC have a lower mean value (ml/kg/day) intake compared to patients without NEC. But due to the limitations of this retrospective cohort study no firm conclusion can be drawn about an association between type and/or amount of feeding between patients with and without NEC.