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Background <p>In Sweden, the incidence of necrotising enterocolitis (NEC) in extremely preterm infants has increased from 6 to 10% over a decade. We examined whether changes in enteral nutrition during the first 2 weeks were associated with growth and development of NEC.</p> Methods <p>The EXPRESS (2004–2007) and EXPRESS 2 (2014–2016) cohorts included infants &lt;27 gestational weeks. NEC diagnoses were validated. Nutritional data were retrieved from four of the six healthcare regions (<i>n</i> = 815). Growth and NEC incidence were compared between cohorts, and odds ratios (OR) were adjusted for early risk factors in a logistic regression model.</p> Results <p>In EXPRESS 2, during the first postnatal week, feeding advancement was more rapid (10 vs. 8 ml/kg/d, <i>p</i> &lt; 0.001) and fortification more common (27% vs. 3.6%, <i>p</i> &lt; 0.001). Growth improved from birth to 28 days (delta <i>z</i>-scores: weight, –2.18 vs. –1.49, <i>p</i> &lt; 0.001; length, –2.22 vs. –1.96, <i>p</i> = 0.013) and to 36 weeks’ postmenstrual age. Neither feeding advancement nor fortification was associated with increased NEC risk &gt;7 d (<i>n</i> = 44; aOR 0.96, 95% CI 0.91–1.01, <i>p</i> = 0.15; aOR 1.33, 95% CI 0.57–2.79, <i>p</i> = 0.50).</p> Conclusion <p>A more active early enteral nutrition policy in Sweden was associated with faster feeding advancement, earlier fortification, increased protein intake, and improved growth without increased NEC risk.</p> Impact <p><UnorderedList Mark="Bullet"> <ItemContent> <p>Human breastmilk fortification increased, and macronutrient intakes improved among extremely preterm infants in Sweden during the years 2014–2016, compared to 2004–2007.</p> </ItemContent> <ItemContent> <p>Weight and length growth improved during the years 2014–2016.</p> </ItemContent> <ItemContent> <p>More active enteral nutrition during 2014–2016 was not associated with an increased incidence of necrotising enterocolitis.</p> </ItemContent> <ItemContent> <p>The study uses validated, population-based data from two national cohorts with high-resolution daily nutrition and growth records.</p> </ItemContent> <ItemContent> <p>Findings support earlier feeding advancement and fortification to improve growth without increasing necrotising enterocolitis risk in extremely preterm infants.</p> </ItemContent> </UnorderedList></p>

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Early enteral nutrition practices and their association with growth and necrotising enterocolitis in extremely preterm infants—A dual national cohort study

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  • 发表日期：

    2026年4月7日

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  • Pontus Challis,
  • Elisabeth Stoltz Sjöström,
  • Anders Elfvin,
  • Lars Naver,
  • Thomas Abrahamsson,
  • Magnus Domellöf

摘要

Background

In Sweden, the incidence of necrotising enterocolitis (NEC) in extremely preterm infants has increased from 6 to 10% over a decade. We examined whether changes in enteral nutrition during the first 2 weeks were associated with growth and development of NEC.

Methods

The EXPRESS (2004–2007) and EXPRESS 2 (2014–2016) cohorts included infants <27 gestational weeks. NEC diagnoses were validated. Nutritional data were retrieved from four of the six healthcare regions (n = 815). Growth and NEC incidence were compared between cohorts, and odds ratios (OR) were adjusted for early risk factors in a logistic regression model.

Results

In EXPRESS 2, during the first postnatal week, feeding advancement was more rapid (10 vs. 8 ml/kg/d, p < 0.001) and fortification more common (27% vs. 3.6%, p < 0.001). Growth improved from birth to 28 days (delta z-scores: weight, –2.18 vs. –1.49, p < 0.001; length, –2.22 vs. –1.96, p = 0.013) and to 36 weeks’ postmenstrual age. Neither feeding advancement nor fortification was associated with increased NEC risk >7 d (n = 44; aOR 0.96, 95% CI 0.91–1.01, p = 0.15; aOR 1.33, 95% CI 0.57–2.79, p = 0.50).

Conclusion

A more active early enteral nutrition policy in Sweden was associated with faster feeding advancement, earlier fortification, increased protein intake, and improved growth without increased NEC risk.

Impact

Human breastmilk fortification increased, and macronutrient intakes improved among extremely preterm infants in Sweden during the years 2014–2016, compared to 2004–2007.

Weight and length growth improved during the years 2014–2016.

More active enteral nutrition during 2014–2016 was not associated with an increased incidence of necrotising enterocolitis.

The study uses validated, population-based data from two national cohorts with high-resolution daily nutrition and growth records.

Findings support earlier feeding advancement and fortification to improve growth without increasing necrotising enterocolitis risk in extremely preterm infants.