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Minimizing Variance in Gastroschisis Management Leads to Earlier Full Feeds in Delayed Closure
Elizabeth A Gilliam1, Kathryn Vu1, Pavithra Rao1
1Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health and Sciences University, Portland, Oregon.
Insights
A new gastroschisis management protocol standardized care without increasing complications. Infants with delayed closure reached full feeds faster, suggesting this approach should not slow nutritional advancement.
Area of Science:
- Pediatric Surgery
- Neonatal Nutrition
- Gastrointestinal Motility
Background:
- Limited guidance exists on feeding initiation and advancement timing for gastroschisis.
- Gastroschisis management protocols can standardize antibiotic and nutritional treatments.
- A care protocol was implemented to standardize feeding protocols for gastroschisis patients.
Purpose of the Study:
- To evaluate the impact of a gastroschisis management protocol on feeding timelines and complications.
- To standardize antibiotic and nutritional treatment for gastroschisis patients.
- To compare feeding initiation and advancement between a control group and a protocol group.
Main Methods:
- Retrospective comparison of simple gastroschisis patients at two hospitals before and after protocol implementation.
- Exclusion of complicated gastroschisis and early mortality cases.
- Analysis of time to feed initiation, time to goal feeds, length of stay, and complications.
Main Results:
- Protocol compliance was 76% with no increase in complication rates.
- No significant difference in length of stay or time to full feeds overall.
- Neonates undergoing delayed closure reached full feeds significantly earlier (9 days vs. 15 days).
Conclusions:
- The gastroschisis management protocol effectively standardized care without adverse effects.
- Delayed closure in gastroschisis should not be a reason for slower nutritional advancement.
- Further research is needed on the impact of early enteral nutrition on rare complications and necrotizing enterocolitis.
Background:
Limited guidance exists regarding appropriate timing for feed initiation and advancement in gastroschisis. We hypothesized that implementation of a gastroschisis management protocol would allow for standardization of antibiotic and nutritional treatment for these patients.
Methods:
We conducted a retrospective comparison of patients with simple gastroschisis at two pediatric hospitals before and after initiation of our gastroschisis care protocol. Complicated gastroschisis and early mortality were excluded. The control group extended from January 2012 to January 2014 and the protocol group from July 2014 to July 2016. Variables of interest included time to feed initiation, time to goal feeds, length of stay, and National Surgical Quality Improvement Program-defined complications. We performed a subgroup analysis for primary versus delayed gastroschisis closure. Statistical analyses, including F-tests for variance, were conducted in Prism.
Results:
Forty-seven patients with simple gastroschisis were included (control = 22, protocol = 25). Protocol compliance was 76% with no increase in complication rates. There was no difference in length of stay or time from initiation to full feeds overall between the control and protocol groups. However, neonates who underwent delayed closure reached full feeds significantly earlier, averaging 9 d versus 15 d previously (P = 0.04).
Conclusions:
For infants undergoing delayed closure, the time to full feeds in this group now appears to match that of patients undergoing primary closure, indicating that delayed closure should not be a reason for slower advancement. Additional studies are needed to assess the impact of earlier full enteral nutrition on rare complications and rates of necrotizing enterocolitis.
