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Early Commencement of Enteral Feeds in Gastroschisis: A Systematic Review of Literature
Madhuri Dama1, Uday Rao2, Ian Gollow3
1Department of General Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
Insights
Early commencement of enteral feeds (CEF) in infants with gastroschisis may lead to faster full enteral feeds (FEF) and shorter hospital stays. This systematic review suggests delaying CEF is associated with prolonged parenteral nutrition and hospitalization.
Area of Science:
- Neonatal surgery and gastroenterology
- Clinical nutrition and outcomes research
Background:
- Gastroschisis is a congenital defect with no established strategies for improving feed tolerance.
- Early commencement of enteral feeds (CEF) benefits preterm infants, suggesting potential benefits for gastroschisis infants.
Purpose of the Study:
- To systematically review the association between the timing of CEF and key outcomes in gastroschisis.
- To evaluate the impact of CEF timing on time to full enteral feeds (FEF), duration of parenteral nutrition (PN), and hospital stay (HS).
Main Methods:
- Systematic review of PubMed, EMBASE, Cochrane CENTRAL, and conference abstracts (search conducted December 2015).
- Inclusion of studies of any design reporting CEF timing and relevant outcomes.
- Meta-regression analysis to determine the association between CEF timing and outcomes.
Main Results:
- No randomized controlled trials were identified; 42 observational studies (4,835 infants) were included.
- Each day delay in CEF was significantly associated with a delay in FEF (1.4 days), PN duration (2.05 days), and HS (1.91 days).
- Sensitivity analysis confirmed benefits of early CEF, even when excluding complex gastroschisis cases.
Conclusions:
- Early commencement of enteral feeds (CEF) appears to be associated with earlier achievement of full enteral feeds (FEF) in infants with gastroschisis.
- Urgent need for randomized controlled trials to compare early versus delayed CEF in gastroschisis populations.
Abstract:
Introduction There are no evidence-based strategies to improve feed tolerance in gastroschisis. Early commencement of enteral feeds (CEF) is known to improve feed tolerance in preterm infants. It is possible that infants with gastroschisis may also benefit from early CEF. Objective To conduct a systematic review to evaluate the relationship between time of CEF, and time to reach full enteral feeds (FEF), duration of parenteral nutrition (PN), and duration of hospital stay (HS). Methods PubMed, EMBASE, Cochrane CENTRAL, and relevant conference abstracts were searched in December 2015. Studies of any design reporting on time to CEF and one or more of the outcomes of interest were included. Meta-regression analysis was conducted to find the association between time to CEF and the outcomes of interest. Results There were no randomized controlled trials (RCTs) comparing early (≤7 days from birth) versus delayed (>7 days) CEF. Forty-two observational studies on gastroschisis (4,835 infants) where feed-related information was available were included. Meta-regression results indicated that each day delay in CEF was associated with a delay of an additional 1.4 days (95% confidence interval [CI]: 0.95, 1.85) to FEF, 2.05 days (95% CI: 1.50, 2.59) to the duration of PN, and 1.91 days (95% CI: 1.37, 2.45) to the duration of HS. Sensitivity analysis after excluding studies that provided information exclusively on complex gastroschisis continued to show beneficial effects of early CEF. Conclusion Early CEF may be associated with early attainment of FEF in gastroschisis. RCTs comparing early versus delayed CEF are needed urgently.
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