Nutritional management and postoperative prognosis of newborns submitted to primary surgical repair of gastroschisis

Abstract

Early start of enteral feeding and small, gradual increase of volume can shorten the use of parenteral nutrition. This management strategy contributes to reduce the incidence of infection and length of hospital stay of newborns with gastroschisis.

Use of a Gastroschisis Feeding Guideline to Improve Standardization of Care and Patient Outcomes at an Urban Children's Hospital

“…Full enteral feeding at a median of 18 days on the GS guideline is consistent with the current literature for feeding advancement in infants with simple gastroschisis. 27 Although the infants managed on the 1-day feeding guideline reached FEN in a shorter period of time (11 days), we contend that this difference is minimally clinically Consistent with previous studies, we found that although increasing the rate of feeding advancement can result in a shorter time to FEN in infants with gastroschisis, this speed brings with it a risk of NEC. 28 We designed our GS guideline to limit this risk by advancing feeding every other day for the first half of the feeding advancement process.…”

Differences in attitudes to feeding post repair of Gastroschisis and development of a standardized feeding protocol

“…Gastroschisis occurs in 5 of 10,000 live births with a survival of greater than 90% however, there is often significant associated morbidity [3, 4]. Difficulties in commencing and progressing enteral feeds [5, 6], is well recognized in this group and this difficulty is thought to be due to the poor gut motility as a result of the bowel exposure and thickening. The delay in the establishment of enteral feeds often contributes to lengthy requirements for central venous access, dependence on total parenteral nutrition (TPN), small bowel bacterial overgrowth (SBBO), increased risk of sepsis and TPN related cholestasis.…”

Profile of Newborns With Gastroschisis Diagnosis in a Public Hospital at Porto Alegre/Rs

“…However, a study conducted in the state of Minas Gerais, southeastern Brazil, found higher mortality rates (14.7%) compared to developing countries 11 , with deaths usually occurring among neonates with intestinal impairment or sepsis 7 . With regard to treatment of the NB with gastroschisis in the immediate postpartum period, a silo, i.e., a polyvinyl chloride (PVC) bag, helps prevent heat and fluid loss and allows for intestinal loops to be returned to the abdominal cavity until the surgical closure of the abdominal wall 7 .…”

“…Primary closure consists of abdominal fascial closure after reduction of eviscerated loops, and staggered (or secondary) closure uses a silo to hold the exposed loops and reduce them gradually after surgery, resulting in the correction of the defect or including surgical reinterventions 5 to 10 days after primary closure 7 . The most common postoperative complications consist of necrotizing enterocolitis, short bowel syndrome, malabsorption, intestinal obstruction, and cholestasis, due to prolonged use of parenteral nutrition 9,10 , but neonate dietary tolerance is increased when diet is gradually started with smaller volumes 11 . The relevance of the present study lies on the importance of gastroschisis as an abdominal wall malformation considered as a rare event with a multifactorial etiology 12 .…”

“…Intrauterine growth restriction may be influenced by loss of nutrients and proteins through intestinal exposure to amniotic fluid causing secondary growth deprivation 19 . This fact may lead to a lower tolerance to the progression of enteral feeding, requiring longer time of parenteral nutrition and thus longer hospital stay 11 . It is worth emphasizing that this study did not investigate variables related to parenteral nutrition, antibiotic therapy, and length of hospital stay among cases of gastroschisis.…”