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Effect of timing of enteral feeding on outcome in gastroschisis
Akram Aljahdali1, Noosheen Mohajerani, Erik D Skarsgard
1Department of Surgery, Division of Pediatric Surgery, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
Insights
Starting enteral nutrition between 8 and 21 days after gastroschisis (GS) closure improves outcomes. Delayed feeding beyond 7 days in GS patients is linked to longer hospital stays and increased complications.
Area of Science:
- Pediatric Surgery
- Neonatal Nutrition
- Gastrointestinal Surgery
Background:
- Optimal outcomes in gastroschisis (GS) depend on timely enteral nutrition.
- The timing of initiating first feeds post-closure is a critical factor.
Purpose of the Study:
- To investigate the impact of the timing of first feeds on patient outcomes in gastroschisis.
Main Methods:
- A national database of 570 gastroschisis cases (May 2005-August 2011) was analyzed.
- Key variables included gestational age, illness severity, bowel injury severity, and days to first feed (DTF).
- Outcomes assessed were total parenteral nutrition (TPN) duration, length of stay (LOS), and infectious complications, using descriptive, univariate, and multivariate regression.
Main Results:
- Mean DTF was 17 ± 15 days, with 16% of cases having high-risk bowel injury.
- Initiating feeds between 8-21 days post-closure correlated with reduced TPN duration and LOS.
- Multivariate analysis confirmed DTF as an independent predictor of TPN duration, LOS, and infectious complications.
Conclusions:
- Days to first feed (DTF) post-closure is a significant predictor of outcomes in gastroschisis.
- The optimal window for initiating feeds appears to be between 8 and 21 days for improved patient outcomes.
Background:
Timely initiation of enteral nutrition is pivotal to outcome optimization in gastroschisis (GS). The purpose of our study was to analyze the effect of timing of first feeds on outcome.
Method:
GS cases accrued between May 2005 and August 2011 were abstracted from a national database. Risk variables evaluated included GA, illness severity, bowel injury severity, and post-closure days to first feed (DTF). The outcomes analyzed included duration of TPN, LOS, and infectious complications. Descriptive, univariate, and multivariate regression analyses were conducted.
Results:
The study cohort comprised 570 cases (16% with "high risk" bowel injury). Group distribution by DTF was: 0-7 days (12%), 8-14 days (44%), 15-21 days (26%), and >21 days (17%), with a mean DTF of 17 ± 15 days. Mean durations of TPN and LOS were 44 ± 56 and 112 ± 71 days, respectively. DTF subgroups were comparable, except for a greater proportion of "high risk bowel injury" in DTF>21 days. Initiation of feeds between 8 and 21 days was associated with fewer TPN days and reduced LOS. Multivariate analyses revealed that TPN duration, LOS, and infectious complications were independently predicted by DTF.
Conclusions:
Post-closure DTF predicts outcome in GS, with best outcomes observed when feeds are started 7 days post-closure.
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