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Early Closure of Gastroschisis After Silo Placement Correlates with Earlier Enteral Feeding
Jamie Harris1, Jennifer Poirier1, Debra Selip2
1Division of General Surgery, Rush University Medical Center. 1653 W. Congress Parkway Jelke Suite 792, Chicago.
Insights
Earlier definitive closure of gastroschisis after silo placement is linked to earlier initiation of enteral feeds and faster progression to full feeds, improving patient outcomes.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Anomalies
Background:
- Gastroschisis is a significant congenital anomaly affecting newborns.
- Early enteral feeding is crucial for improved outcomes in neonates with gastroschisis.
Purpose of the Study:
- To investigate the relationship between the timing of definitive gastroschisis closure and the initiation of enteral feeds.
- To test the hypothesis that earlier closure leads to earlier feed initiation.
Main Methods:
- Retrospective review of 43 gastroschisis patients (2005-2014).
- Analysis of data including time to definitive closure, first feeds, and full feeds.
- Statistical analysis using Spearman's rho and Kruskal-Wallis tests (p<0.05 significance).
Main Results:
- Earlier gastroschisis closure correlated significantly with earlier initiation of first feeds (p=0.0001).
- Earlier closure also correlated with a shorter time to full feeds (p=0.018).
- A trend towards earlier feeding was observed with closure by day of life 4 (p=0.13).
Conclusions:
- Earlier definitive closure of gastroschisis post-silo placement is associated with improved feeding timelines.
- This suggests optimizing closure timing may enhance neonatal recovery.
Objectives:
Gastroschisis is a congenital anomaly affecting 2.3-4.4/10,000 births. Previous studies show initiation of early enteral feeds predicts improved outcomes. We hypothesize that earlier definitive closure after silo placement; can lead to earlier enteral feed initiation. Design/ Setting/ Duration: Retrospective review of patients with gastroschisis from 2005 and 2014 at a single institution.
Material And Methods:
The data, including ethnicity, gestational age, birth weight, time to definitive closure, and time of first and full feeds, were analyzed using both Spearman's rho and the Kruskal-Wallis rank sum test where appropriate; a p value less than 0.05 was considered significant.
Results:
Forty-three patients (24 males, 19 females) born with gastroschisis were identified. Overall survival rate was 88% (38/43). Forty of the 43 patients had a silo placed prior to definitive closure. Median days to closure were 6 (0 to 85) days. First feeds on average began on day of life (DOL) 17, and full feeds on DOL 25. Earlier closure of gastroschisis correlated with early initiation of feeds (p=0.0001) and shorter time to full feeds (p=0.018), closure by DOL4 showed a trend toward earlier feeding (p=0.13).
Conclusion:
Earlier closure of gastroschisis after silo placement was associated with earlier feed initiation and shorter time to full feeds.
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