Optimal enteral feeding after surgery for necrotising enterocolitis: a systematic review

To review the evidence for enteral feed modification after surgery for Necrotising Enterocolitis (NEC) and determine the optimal feeding regime for these babies. A systematic review of the Scopus and PubMed databases was carried out. Papers reporting feed regimes in babies following surgery for NEC and reporting at least one clinical outcome were included. The ROBINS-I tool was utilised to evaluate the risk of bias. The search strategy returned 2772 records. After deduplication and screening against the inclusion/exclusion criteria, 11 studies were included in the review. Three studies reported the implementation of a standardised feeding regime; one led to earlier introduction of enteral feed, two found no increase in NEC recurrence and all three saw a reduction in liver dysfunction. There is a paucity of high quality evidence to guide specific post-operative feeding strategies in infants following surgery for NEC. However, limited available data suggest that achieving early enteral nutrition is not associated with worse short-term outcomes and may be associated with reduced parenteral nutrition dependence, improved growth, and lower feed-related complications. Large prospective and multicentre studies are needed to define optimal feeding composition, timing and advancement strategies to improve post-operative outcomes in this vulnerable neonatal population.