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Use of Breast Milk and Other Feeding Practices Following Gastrointestinal Surgery in Infants
Sanskriti Varma1, Edward L Bartlett2, Lucy Nam1
1The Johns Hopkins University School of Medicine.
Insights
Most infants start mother's milk (MM) after surgery, but less than half receive it at discharge. Infants with necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) require close growth monitoring post-discharge.
Area of Science:
- Pediatric Surgery
- Neonatal Nutrition
- Gastroenterology
Background:
- Enteral feeding is crucial for infants recovering from gastrointestinal surgery.
- Optimizing nutritional support impacts surgical outcomes and long-term growth in neonates.
- Understanding feeding practices is essential for improving care in this vulnerable population.
Purpose of the Study:
- To characterize enteral feeding practices in infants following gastrointestinal surgery.
- To evaluate the use of mother's milk (MM) and formula in the postoperative period.
- To assess growth outcomes in relation to feeding modalities and diagnoses.
Main Methods:
- Retrospective analysis of 111 infants (<6 months) who survived to enteral feeding post-intestinal surgery (2012-2017).
- Data collected included demographics, surgical details, feeding practices, and growth parameters.
- Infants were compared based on initial diagnosis: necrotizing enterocolitis (NEC), gastroschisis, atresia, spontaneous intestinal perforation (SIP), and others.
Main Results:
- 77% of infants received MM initially, but this varied by diagnosis (P=0.004).
- NEC infants were least likely to continue MM (7%) and more likely to receive elemental formula.
- Only 44% received MM at discharge, and 25% at 1 year; 58% were discharged with feeding tubes.
- Infants with NEC and SIP experienced growth failure at 3 months post-discharge (z scores < -3.0) but recovered by 1 year.
Conclusions:
- Despite initial use, mother's milk (MM) consumption significantly decreases by discharge and 1-year follow-up.
- Infants with necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) require vigilant growth monitoring after hospital discharge.
- Current enteral feeding practices may not fully support sustained mother's milk intake or optimal early growth in surgically treated infants.
Objectives:
The aim of the study was to characterize the enteral feeding practices in infants after gastrointestinal surgery.
Methods:
We performed a retrospective analysis of infants who underwent intestinal surgery at age <6 months who survived to be fed enterally between January 2012 and June 2017. Demographics, surgical characteristics, feeding practices, and growth-related outcomes during hospitalization, discharge, and follow-up (3, 6, and 12 months) were obtained from the electronic medical records. Descriptive statistics compared infants by their initial diagnosis.
Results:
We reviewed 111 infants: necrotizing enterocolitis (NEC) = 21, gastroschisis = 28, atresia = 27, spontaneous intestinal perforation (SIP) = 18, and other diagnoses = 17. Most infants (77%) received mother's milk (MM) as the first postoperative feed, but this differed by diagnosis (P = 0.004). Donor milk was used in 11%, most commonly in infants with NEC and SIP. Infants with NEC were least likely to continue MM in the hospital (7%, P = 0.0014) and were more likely to receive elemental formula. Only 44% of infants received MM at discharge. After 1 year, 25% were fed MM. The majority of infants were discharged with feeding tubes (nasogastric: 35%, gastric: 23%). Although all groups had acceptable weights at discharge, infants with NEC (z score: -1.8) and SIP (z score: -1.1) showed growth failure at 3 months (z scores: -3.3, -3.2, respectively, P < 0.0001), but had appropriate gain by 1 year (z scores: -1.1, -1.7, respectively).
Conclusions:
Despite most infants receiving MM in the early postoperative period, <50% at discharge and only 33% at 1-year still received MM. Weight gain after discharge in infants with NEC and SIP warrants close monitoring.
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