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Long-term growth and neurodevelopmental outcomes of a standardized gastroschisis feeding protocol: A retrospective
Amit Trivedi1, Smriti Singh2, Annabel Webb3
1Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Insights
A standardized feeding protocol for neonates with gastroschisis improved hospital efficiency, reducing length of stay and total parenteral nutrition. Long-term growth and neurodevelopmental outcomes at one year were not compromised.
Area of Science:
- Neonatal surgery and critical care
- Pediatric gastroenterology and nutrition
- Developmental pediatrics
Background:
- Gastroschisis is a congenital defect requiring complex neonatal management.
- Optimizing feeding protocols is crucial for improving outcomes in these infants.
- Long-term growth and neurodevelopmental impacts of feeding interventions need evaluation.
Purpose of the Study:
- To assess the long-term effects of a standardized feeding protocol on neonates with simple gastroschisis.
- To evaluate impacts on growth parameters and neurodevelopmental assessments up to one year of age.
- To analyze changes in neonatal intensive care unit (NICU) length of stay and total parenteral nutrition (TPN) duration.
Main Methods:
- Retrospective cohort study comparing outcomes before and after implementing a standardized feeding protocol.
- Included 126 neonates with simple gastroschisis, divided into pre-protocol (n=55) and post-protocol (n=71) groups.
- Primary outcomes: anthropometric growth z-scores and neurodevelopmental assessments at 3 and 12 months. Secondary outcomes: NICU LOS and TPN duration.
Main Results:
- The post-protocol group showed higher weight z-scores at 3 months but not at 12 months.
- No significant differences in cognitive or motor delays at 12 months; transient language delay reduction at 3 months did not persist.
- Protocol significantly reduced TPN duration (455.9 vs 624.5 hours) and NICU length of stay (25.5 vs 34.5 days).
Conclusions:
- Standardized feeding protocols enhance acute care efficiency for gastroschisis infants, reducing hospital stay and TPN dependence.
- Protocolized feeding is safe, showing no adverse long-term effects on growth or neurodevelopment up to one year.
- Findings support the implementation of standardized feeding protocols in the management of simple gastroschisis.
Aim:
To evaluate the long-term impact of a standardized feeding protocol on growth and neurodevelopmental outcomes in neonates with simple gastroschisis.
Methods:
A single-center, retrospective cohort study compared pre- and post-feeding protocol outcomes for neonates with simple gastroschisis. Primary outcomes included anthropometric growth z-scores and neurodevelopmental assessment at three and twelve months. Secondary outcomes included neonatal intensive care unit length of stay and total parenteral nutrition duration.
Results:
The study included 126 neonates admitted from January 2010 to June 2024, categorized into pre-protocol (n = 55) and post-protocol (n = 71) cohorts. In the multivariate linear regression analysis, the post-protocol group demonstrated significantly higher weight z-scores at 3 months (Beta = 0.64, 95% CI: 0.01 to 1.22; p = 0.029), though this advantage was not sustained at 12 months. Neurodevelopmental assessment revealed no significant differences in cognitive or motor delays at 12 months. A transient reduction in language delay was observed at three months in the post-protocol group (7.1% vs 29.2%, adjusted OR 0.06; p = 0.039), but this did not persist at one year. The protocol was associated with significantly reduced duration of total parenteral nutrition (455.9 h vs 624.5 h; p = 0.009) and shorter length of stay (25.5 days vs 34.5 days; p = 0.004). Attrition analysis showed no significant clinical differences despite higher post-protocol follow-up loss.
Conclusion:
Standardized feeding protocol significantly improved acute care efficiency by reducing hospital stay and reliance on total parenteral nutrition without compromising long-term growth trajectories or neurodevelopmental outcomes at one year of age. These findings confirm the safety of protocolized feeding for simple gastroschisis.
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