OBJECTIVE: This study examines health outcomes associated with a simple gastroschisis-specific enteral feeding guideline at the Le Bonheur Children’s hospital in Memphis, TN.
METHODS: This retrospective study compares a post-intestinal surgery protocol (PISP) August 1, 2009 through August 31, 2013 (n=43) a gastroschisis-specific protocol September 1, 2013 through June 30, 2015 (n=17). PISP babies had feeding increases every day, three days, or a combination of these. Infants were classified based on their starting guideline, yielding a 1-day (n=29) and a 3-day group (n=14). Babies treated after September 1, 2013 received enteral intake increases every other day until 50% of target and then were advanced every day.
RESULTS: The groups were not significantly different by sex, race, gestational age, or birth weight. There was a significant difference in median time to full enteral nutrition: 10 days (1-day), 18 days (new), and 22 days (3-day; p<0.01). Feeding intolerance episodes (13 v. 6 v. 6; p=0.81), daily weight gain (17.4 v 19.7 v. 19.2; p=0.25), and length of stay (37 v. 40 v. 51; p=0.15) were not significantly different. Two infants developed NEC; both were advanced daily. There were 4 complications in the 1-day, 1 in the 3-day, and 1 with the new guideline (p=0.86). Median percent adherence was over 85% (88 v. 92 v. 94; p=0.35).
CONCLUSION: Median time to full enteral nutrition for simple gastroschisis infants was shortest with daily feeding advancement. A gastroschisis-specific protocol yielded comparable LOS, fewer in-hospital complications, fewer episodes of feeding intolerance, and zero cases of NEC.
