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

Saloni Balgi, Sarita Singhal, Georgia Mueller, Beau Batton, Saloni Balgi, Sarita Singhal, Georgia Mueller, Beau Batton

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 gastroschisis Setting: Level III neonatal intensive care unit in a free-standing Children's Hospital Duration: 13.5 years

Materials & 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.

Keywords: Enteral nutrition; Gastroschisis; Growth; Preterm infant.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4617017/bin/jns-4-42.f1.jpg
Figure 1: Median postmenstrual age (in weeks) of feeding achievements for term and preterm infants with gastroschisis.
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4617017/bin/jns-4-42.f2.jpg
Figure 2: Relationship between gestational age at birth and postmenstrual age at initial hospital discharge for infants with gastroschisis.
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4617017/bin/jns-4-42.f3.jpg
Table 1: Maternal and Infant Demographic Data
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4617017/bin/jns-4-42.f4.jpg
Table 2: Surgical Managament, Enteral nutrition, and in-hospital growth data

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