Correlation between duration of postoperative parenteral nutrition and incidence of postoperative complication in gastroschisis patients.
BACKGROUND
Gastroschisis is the most common neonatal anterior abdominal wall defect. Since all neonatal infants with gastroschisis require total parenteral nutrition (TPN), the authors retrospectively review was to find correlation between duration of TPN and postoperative complications including necrotizing enterocolitis (NEC) and poor feeding in gastroschisis patients. The secondary objective of the present study was to find correlation(s) among length of stay (LOS), gestational age (GA), birthweight (BW), type of operation and postoperative complications.


METHODS
Forty-one gastroschisis patients were reviewed during 2001 to 2006. Postoperative complications were analysed among duration of TPN, LOS, GA, BW, and type of operation. Multiple parameters affecting gastroschisis patients with NEC were compared with those without NEC.


RESULTS
There were 21 male and 20 female infants. Normal labour was the major route of delivery (31 in 39 infants). Complications from TPN usage included line infection 5/40, central line requirement 9/40, cutdown requirement 5/40, sepsis 7/40, and TPN leakage 1/40. NEC and poorfeeding were 6/40 and 9/40 respectively In the present study the Incidence of NEC in gastroschisis was 15%. NEC and poor feeding were significantly correlated with longer TPN administration (p = 0.0046 & p = 0.0042). Lowest bodyweight of gastroschisis infants occured in the 5.39 +/-3.19 days after birth. Gastroschisis patients with NEC were frequently found with low birthweight and premature (p = 0.007 & 0.028). All gastroschisis infants with NEC were delivered vaginally. No correlation was shown between time to first oral feeding and development of NEC (p = 0.964).


CONCLUSIONS
Longer TPN administration time was found in gastroschisis patients with NEC and poor feeding. Duration of NPO after operation did not associate with NEC development. NEC was more likely to occur in gastroschisis patients with low birthweight and prematurity. All of the gastroschisis infants with NEC were born through the vaginal route. Like other newborn babies, gastroschisis patients lose their bodyweight during the first week of life and gradually gain bodyweight thereafter
Mungnirandr
Akkrapol
A
Division of Pediatric Surgery, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Khorana
Jiraporn
J
Ruangtrakool
Ravit
R
D015331:Cohort Studies; D020345:Enterocolitis, Necrotizing / Q000150:complications; D005260:Female; D020139:Gastroschisis / Q000150:complications / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors