I'm not sure if any reliable prevention strategy for NEC does really exist. However, human milk should be preferred, if available and give ASAP after birth to maintain correct microflora and adequate bowel blood flow. Accurate cardiocirculatory stability maintainance is advised, taking great care in case of requirement for pharmacological closure of PDA. Probiotics such as lactorferrin sould be administered on a daily basis as a prophylaxis.

Nonetheless, I do not believe that an absolute method to avoid or prevent NEC does really exist.

This is a very interesting question and your study helps by suggesting a way that we might look at preventing NEC. Unfortunately, the biggest difficulty of delaying feeding is that we must rely on intravenous feeding with all the attendant risks and complications. Most concerning is the potential for bacterial and fungal infections to be introduced via lengthy use of catheters. Parenteral nutrition as well being vitally needed by sick preterm infants is also an ideal culture medium for bacteria and fungi to take advantage of.

It is therefore entirely possible that although preventing NEC, other complications lead to a poorer overall outcome in such babies if it takes longer to reach full feeds and to remove central lines. For these (and other reasons) we are about to start a large (n=2500) randomised trial of increasing milk feeds at 30ml/kg/day v 18ml/kg/day in infants < 32 weeks or

Its interesting to know NEC is still a problem that needs some guidelines and updates.

The information I have in my computer on this subject is to encourage mothers to express breast milk (EBM); there is evidence that this is better tolerated with a lower risk of necrotising enterocolitis; there may be a benefit in DQ at 18 months.

This may be due to the presence of long chain polyunsaturated fatty acids such as g-or-linoleic acid, eicosapentanoic acid or docosahexenoic acid.

These fatty acids which are omega-6 and omega-3 fatty acids, may not be metabolised as efficiently in preterm babies who have a relative inactivity of the enzyme delta-6 desaturase. These are present in breast milk but not in most formula milks. Although some newer preterm formulas contain them (Cow & Gate Nutriprem, Milupa Prematil the right concentrations are not fully established and we should await further research before adopting any one of these milks as the routine formula feed for those preterms whose mothers cannot provide their own milk.

Donor Breast Milk (DBM) has been used in some hospitals to initiate feeds in small babies (

The different ,gestation,maturity and illness in children,makes it difficult to prescribe one solution for a complex problem.Antenatal factors ,influence the way the  child copes with  nutrition.The gold standard to feeding has always been Breast milk,for  various reasons ,mentioned above by my colleagues.Unfortunately ,breast milk quality and quantity may be inadequate or below the required  standards for the child.It is well documented that mothers who have had antibiotics ,prior to labour have different breast milk flora compared to those who do not take antibiotics.

Careful history to identify maternal illness along with  antenatal scan,to look for doppler blood flow helps in planning a tailor made feeding regime for neonates.

Absent or reduced doppler flow in a neonates needs to be viewed with some suspicion, with regards to immediate enteral feeding.