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Patel EU, Wilson DA, Brennan EA, Lesher AP, Ryan RM. Earlier re-initiation of enteral feeding after necrotizing enterocolitis decreases recurrence or stricture: a systematic review and meta-analysis. J Perinatol. 2020 Nov;40(11):1679-1687. doi: 10.1038/s41372-020-0722-1. Epub 2020 Jul 18. PMID: 32683411; PMCID: PMC7368613.

Objective: To assess the effects of earlier vs. later re-initiation of enteral feeds after necrotizing enterocolitis (NEC).

Study design: We reviewed the literature to assess timing of enteral feeding after NEC using fixed effects models.

Results: Three studies met inclusion criteria; no randomized trials. After removal of Bell’s Stage I infants, the earlier refeeding group (<5-7 or median 4 days) included 79 infants and later refeeding group (≥5-7 or median 10 days) included 119 infants. Pooled analysis revealed earlier re-initiation reduced the incidence in the composite outcome of recurrent NEC and/or post-NEC stricture (OR = 0.27; 95% Cl = 0.10-0.75; p = 0.012). Individually, NEC recurrence (pooled OR = 0.34; 95% Cl = 0.09-1.29; p = 0.112) or stricture (OR = 0.34; 95% Cl = 0.09-1.26; p = 1.06) did not differ between groups.

Conclusions: There was no increase in negative outcomes with earlier refeeding after NEC. Earlier initiation of enteral feeds resulted in a significantly lower risk for the combined outcome of recurrent NEC and/or post-NEC stricture.

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