Prospective study of the incidence and complications of bacterial contamination of enteral feeding in neonates

Purpose: The goal of this study was to determine incidence of, and complications resulting from, bacterial contamination of enteral feedings in neonates. Methods: A prospective study of 50 tube-fed neonates was conducted. Infants were bolus fed via an open gravity drained system; demographic and clinical data were gathered. The lumen of the tube was cultured quantitatively after 7 days. All organisms were isolated, identified, frozen, and stored to correlate with clinical cultures. Results: The 50 neonates were fed for a mean of 17.6 days each and represent 125 patient weeks (1 tube per patient per week). A total of 71 of 125 tubes were "contaminated" (>1,000 colony forming units [CFU]/mL), with a mean 908,173 CFU and 3 different bacteria types. Among formulafed infants, feeding intolerance occurred in 24 of 32 weeks with contaminated tubes versus 0 of 44 weeks with noncontaminated tubes (P > .05). Contamination occurred in 41 of 48 weeks in patients on H2 antagonists versus 32 of 66 weeks in patients with normal gastric acidity (P > .05). Necrotizing enterocolitis developed in 7 patients; all were fed formula contaminated with greater than 100,000 CFU/mL of Gramnegative bacteria. Four required operation; intraoperative cultures found the same organism as cultured previously in the tube in all 4 infants. Conclusion: Bacterial contamination of enteral feeding occurs frequently, causes significant feeding intolerance, and may contribute to NEC.