Neonatal outcome of gastroschisis is mainly influenced by nutritional management.
OBJECTIVE
The aim of the study was to evaluate early minimal enteral feeding (MEF) and gradual enteral nutrition increment on neonatal outcome of gastroschisis.


METHODS
An intervention group was prospectively assessed and compared with an observational historical control group. The prospective study relied on a new protocol of enteral nutrition. According to the new protocol, MEF was initiated 5 days after bowel reintegration and milk amounts were increased 12 mL/kg/day. In the control group, enteral nutrition was delayed until resolution of postoperative ileus, and increment of feeding was not systematized.


RESULTS
Twenty-two patients were included in the MEF group and compared with 51 control patients. Infants in the control group had lower gestational age (36 vs 35 gestational weeks [GW], P=0.03) and birth weight (2465 vs 2200 g, P=0.05). Time to first enteral nutrition (5 vs 11.5 days, P=0.0005) was significantly shorter in the MEF group. All patients in this group were fully enteral fed at day 60, though 30.4% of patients in the control group still needed parenteral nutrition at day 60 (P=0.004). Incidence of nosocomial infection was reduced (9% of patients vs 40%, P=0.016) and hospital stay tended to be shorter in the MEF group (40 vs 54.5 days, P=0.08). In the univariate analysis, factors influencing the length of parenteral nutrition during the 2 periods were the severity of perivisceritis and new nutritional protocol. In the multivariate analysis, only nutritional protocol was significantly associated with the length of parenteral nutrition (P=0.038).


CONCLUSIONS
Early MEF and controlled increase of nutritional elements after bowel reintegration significantly improved outcome of gastroschisis in newborns.
Walter-Nicolet
Elizabeth
E
Department of Pediatrics, Université Paris-Descartes, Hôpital Necker-Enfants Malades, Paris, France.
Rousseau
Véronique
V
Kieffer
François
F
Fusaro
Fabio
F
Bourdaud
Nathalie
N
Oucherif
Salima
S
Benachi
Alexandra
A
Sarnacki
Sabine
S
Mitanchez
Delphine
D
D000704:Analysis of Variance; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D020139:Gastroschisis / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D008297:Male; D010288:Parenteral Nutrition; D011446:Prospective Studies; D016896:Treatment Outcome