Earlier re-initiation of enteral feeding after necrotizing enterocolitis decreases recurrence or stricture: a systematic review and meta-analysis

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.