Neonatal outcome of gastroschisis is mainly influenced by nutritional management.

Abstract

OBJECTIVE:

The aim of the study was to evaluate early minimal enteral feeding (MEF) and gradual enteral nutrition increment on neonatal outcome of gastroschisis.

PATIENTS AND METHODS:

An intervention group was prospectively assessed and compared with an observational historical control group. The prospective study relied on a new protocol of enteral nutrition. According to the new protocol, MEF was initiated 5 days after bowel reintegration and milk amounts were increased 12 mL/kg/day. In the control group, enteral nutrition was delayed until resolution of postoperative ileus, and increment of feeding was not systematized.

RESULTS:

Twenty-two patients were included in the MEF group and compared with 51 control patients. Infants in the control group had lower gestational age (36 vs 35 gestational weeks [GW], P=0.03) and birth weight (2465 vs 2200 g, P=0.05). Time to first enteral nutrition (5 vs 11.5 days, P=0.0005) was significantly shorter in the MEF group. All patients in this group were fully enteral fed at day 60, though 30.4% of patients in the control group still needed parenteral nutrition at day 60 (P=0.004). Incidence of nosocomial infection was reduced (9% of patients vs 40%, P=0.016) and hospital stay tended to be shorter in the MEF group (40 vs 54.5 days, P=0.08). In the univariate analysis, factors influencing the length of parenteral nutrition during the 2 periods were the severity of perivisceritis and new nutritional protocol. In the multivariate analysis, only nutritional protocol was significantly associated with the length of parenteral nutrition (P=0.038).

CONCLUSIONS:

Early MEF and controlled increase of nutritional elements after bowel reintegration significantly improved outcome of gastroschisis in newborns.

• Authors: Elizabeth Walter-Nicolet, Véronique Rousseau, François Kieffer, Fabio Fusaro, Nathalie Bourdaud, Salima Oucherif, Alexandra Benachi, Sabine Sarnacki, Delphine Mitanchez
• Journal: Journal of pediatric gastroenterology and nutrition (J Pediatr Gastroenterol Nutr) Vol. 48 Issue 5 Pg. 612-7 (May 2009) ISSN: 1536-4801 [Electronic] United States
• PMID: 19367181 (Publication Type: Controlled Clinical Trial, Journal Article)

Topics

• Analysis of Variance
• Enteral Nutrition (methods)
• Female
• Gastroschisis (surgery, therapy)
• Humans
• Infant, Newborn
• Intensive Care, Neonatal
• Male
• Parenteral Nutrition
• Prospective Studies
• Treatment Outcome