The role of early enteral nutrition in protecting premature infants from sepsis.

Care of critically ill, preterm infants is a major challenge. Because of their small size and complex health problems, preterm infants require long-term hospitalization in the intensive care unit where they are exposed to serious microorganisms and other antigens that can overwhelm their immature immune systems. As smaller and more fragile preterm infants are surviving NICU care, these infants are at increased risk for nosocomial infections. Although modern antimicrobial agents are invaluable in the management of infection, they can result in biologic stress to the immature physiology of the preterm infant. Nonpharmacologic strategies to enhance the immunocompetence of the preterm immune systems provide another alternative in the management of these infants. Because the gastrointestinal tract is one of the largest immune organs within the body, strategies to maximize its immune functions can improve the outcome of these infants and help prevent or minimize the risk of infection. One such strategy is the early introduction of enteral feedings designed to stimulate or prime the gut. Early introduction of enteral feedings in the acutely ill preterm infant appears to be well tolerated in a variety of small clinical studies. Although the studies vary considerably in design and variables measured, collectively they show a solid trend toward improved outcomes. By preventing the negative consequences of a prolonged period of NPO, early enteral feedings promote the normal processes of the gut as a physical, mechanical, physiologic, and immunologic barrier. A solid understanding of the pathophysiology of prolonged NPO status and the physiology of the gut's immune properties enables critical care nurses to improve care of these vulnerable NICU patients.