Feeding Intolerance and Poor Growth in Infants with Gastroschisis: Longitudinal Experience with Consecutive Patients over Thirteen Years

Abstract

Objectives: 1) To investigate in-hospital factors associated with delayed tolerance of full volume enteral nutrition and 2) To assess longitudinal growth in a contemporary population of infants with gastroschisis.Design: Retrospective single-center study of all infants with gastroschisisSetting: Level III neonatal intensive care unit in a free-standing Children’s HospitalDuration: 13.5 yearsMaterials & Methods: Detailed data regarding demographics, nutritional support, growth, and infant outcomes was collected for all infants with gastroschisis. Linear regression was used to investigate in-hospital factors associated with feeding intolerance and poor growth.Results: For 52 infants, the median gestational age at birth was 36 weeks, the median postnatal age to achieve full feeds was 22 days, and median in-hospital weight gain was 18 gm/day. With linear regression, there was a positive association between time to full feeds and both hospital length of stay (adjusted R2=0.503, p<0.0001) and (unexpectedly) in-hospital weight gain (adjusted R2=0.125, p=0.0248). There was a negative association between in-hospital weight gain and preterm birth (adjusted R2=0.125, p=0.0356). For infants with longitudinal growth data, 35% had a weight <5th percentile (of whom 67% were preterm).Conclusions: Many infants with gastroschisis have poor growth before and after hospital discharge. Aggressive feeding advancement may be a contributing factor to this finding and preterm infants may be at greater risk for poor growth than term infants.

Neighborhood-level Socioeconomic Position During Early Pregnancy and Risk of Gastroschisis

“…Gastroschisis is an abdominal wall birth defect characterized by the herniation of intestines and other abdominal organs outside the fetal body. It occurs between the fifth and eighth gestational week 16 and is associated with increased infant morbidity 17 . Gastroschisis has significant public health relevance due to its increasing prevalence from 3.6 (1995-2005) to 4.3…”

“…Difficulties transitioning from parenteral to enteral nutritional feedings and changes in the absorption of nutrients prompt digestive complications and feeding intolerance, resulting in consequential effects on the infant. 17 Fortunately, the prognosis of infants with gastroschisis is largely optimistic and the overall quality of life is expectedly normal. 43…”

Neurodevelopmental outcome of patients with congenital gastrointestinal malformations: a systematic review and meta-analysis

“…1 Although survival in these patients has improved over the past decades, morbidity remains high. [2][3][4][5][6][7][8] Recent evidence suggests that there may also be an impact on the central nervous system of these patients. 9 The available literature provides evidence for several pathways implicated in congenital gastrointestinal malformations that may contribute to a negative impact on the developing central nervous system: (1) genetic abnormalities 10 11 ; (2) perinatal influences, such as maternal smoking, 12 use of medication, 13 14 preterm birth 15 and low birth weight 15 ;…”

Antenatal Milk Expression as a Lactation Support Intervention for Parents of Infants With Severe Birth Defects

“…[3][4][5][6][7][8][9][10][11][12][13] Parent's own milk (parental milk) diets and direct chest/breastfeeding have been shown to mitigate adverse clinical outcomes in medically complex infants and infants with birth defects. [3][4][5][7][8][9][10][11][12] Mechanisms of protection are related to both the nutritive and bioactive composition of parental milk. 10,13 Furthermore, as direct chest/breastfeeding is the physiologic norm for infant feeding, direct chest/breastfed infants with noncraniofacial birth defects have demonstrated more rhythmic feeding patterns, better oxygen levels and energy conservation during feeding, and achieve higher rates of growth than their bottle-fed counterparts.…”

“…Parent's own milk (parental milk) diets and direct chest/breastfeeding have been shown to mitigate adverse clinical outcomes in medically complex infants and infants with birth defects 3–5,7–12. Mechanisms of protection are related to both the nutritive and bioactive composition of parental milk 10,13.…”