Enteral nutrition strategies in high-risk newborns

Necrotizing enterocolitis (NEC) is one of the most devastating intestinal disorders in neonates, yet the pathophysiology remains incompletely understood. Prematurity, bacterial dysmicrobia, intestinal ischemia and enteral nutrition are considered to be the fundamental risk factors for the development of necrotizing enterocolitis. Various feeding practices are being studied with the aim to find the best approach to protect infants from the necrotizing enterocolitis. In the group of high-risk neonates, the common practice of delayed introduction of enteral feeding has long been considered as a good rationale. However, in recent years, the importance of enteral nutrition has been extensively studied and it is suggested that minimal enteral feeding may play a beneficial role in the prevention of the disease. Studies proved that the absence of enteral nutrition is associated with intestinal mucosal atrophy, diminished intestinal growth, delayed maturation of intestinal enzymes and increased permeability and bacterial translocation. Minimal enteral feeding can on the other hand stimulate the development of the immature gastrointestinal tract and reduce systemic inflammatory responses by promoting proliferation of gut microbial diversity.