Table 1

Results of survey of NEC prevention practices and unit-level linked outcome analyses

CharacteristicsANZNNCNNFinMBRINNSEN1500SNQSwissNeoNetTuscanNNAll
Units in network, N2830526576124168
Units participating in survey, n (%)27 (96)29 (97)5 (100)26 (100)47 (82)6 (100)9 (75)4 (100)153 (91)
Results of unit level survey
Probiotics Probiotic provision, n (%)25 (93)16 (52)5 (100)0 (0)10 (21)0 (0)7 (78)3 (75)66 (43)
Start of probiotics*, dayNo preference†0–10‡1–302–3No preference†
Probiotic species*L/BLLL/BL/BL‡L/B
Stop at sepsis*NoNo preference†No‡No preference†YesNo‡No
Enteral feeding <26 weeks GA*
Start (day)00–10‡*0–10‡0‡*0–1
Daily rate of advancement, ml/kg/day15–2010–2015–2520–2510–2015201010–20
26–28 weeks GA*
Start (day)000‡0–100‡0‡00–1
Daily rate of advancement, ml/kg/day15–20202520–2520–2510–25202020–25
≤28 weeks GA*
Enteral feed vol. where infants commonly receive milk fortifier*, ml/kg/day≥120100–129100–129No preference†80–10970–89≥12080–89No preference†
Donor milk Available, n (%)10 (37%)25 (81%)5 (100%)0 (0%)20 (42%)6 (100%)5 (56%)4 (100%)74 (48%)
Initiation criteria*No preference†No preference†No GA/BW criteria<32 weeks/<1500 g<34 w<32 weeks/<1500 g<32 weeks/<1500 gNo preference†
Stopping criteria*No preference†No preference†No preference†No preference†No preference†No preference†1800 gNo preference†
Results of unit-level analyses: effect of probiotics, feeding start on day 0 and donor milk availability on outcome of NEC surgery
Units providing probiotics versus not providing probiotics§, OR (95% CI)NA¶0.77
(0.48 to 1.24)
NA¶0.36
(0.14 to 0.93)
NA**0.84
(0.61 to 1.16)††
Units starting to feed on day 0§ versus those starting after day 0 (95% CI) for<26 weeks’ GA1.13
(0.70 to 1.85)
1.63
(0.86 to 3.06)
0.12
(0.02 to 1.02)
1.16
(0.83 to 1.63)††
Units starting to feed on day 0§ versus those starting after day 0 (95% CI) for 26–28 weeks’ GA1.78
(0.76 to 4.15)
1.31
(0.69 to 2.48)
0.13
(0.03 to 0.52)
1.14
(0.74 to 1.75)††
Units providing donor milk§ versus units not providing donor milk OR (95% CI)0.78
(0.37 to 1.66)
0.55
(0.21 to 1.41)
0.86
(0.62 to 1.20)††
  • *Response of ≥50% of units.

  • †Units responses were distributed over entire possible range (see online supplement 2 for detailed responses).

  • ‡Unanimous response of 100% of units.

  • §NEC surgery OR (95% CI) are given for networks with variability in provision of probiotics, feeding start and/or donor milk availability. Adjustment was made for GA, male sex, multiple birth and birth-weight z-score.

  • ¶OR could not be calculated for AZNN and SEN1500 as permission for linking survey and patient data was not available.

  • **OR for probiotics could not be calculated for TuscanNN as all patients were from the three units providing probiotics.

  • ††OR for “All” includes all units in countries allowing linkage between unit survey and cohort study, that is, also those countries where all neonates either received or did not receive intervention.

  • ANZNN, Australian and New Zealand Neonatal Network; B, Bifidobacterium; BW, birth weight; CNN, Canadian Neonatal Network; FinMBR, Finnish Medical BirthRegister; GA, gestational age; INN, Israel Neonatal Network; L, Lactobacillus; N, total number in group; n, number in subgroup; NA, not available; NEC, necrotising enterocolitis; SEN1500, Spanish Neonatal Network; SNQ, Swedish Neonatal Quality Register; SwissNeoNet, Swiss Neonatal Network; TuscanNN, Tuscan Neonatal Network.