Eur J Pediatr Surg 2022; 32(02): 153-159
DOI: 10.1055/s-0040-1721074
Original Article

Does Use of a Feeding Protocol Change Outcomes in Gastroschisis? A Report from the Midwest Pediatric Surgery Consortium

Charlene Dekonenko
1   Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
,
Jason D. Fraser
1   Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
,
Katherine Deans
2   Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Mary E. Fallat
3   Department of Surgery, Norton Children's Hospital, Louisville, Kentucky, United States
,
Michael Helmrath
4   Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
,
Rashmi Kabre
5   Department of Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
,
Charles M. Leys
6   Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, United States
,
R Cartland Burns
7   Division of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States
,
Kristine Corkum
5   Department of Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
,
Patrick A. Dillon
8   Department of Surgery, St Louis Children's Hospital PACT, St. Louis, Missouri, United States
,
Cynthia Downard
3   Department of Surgery, Norton Children's Hospital, Louisville, Kentucky, United States
,
Tiffany N. Wright
3   Department of Surgery, Norton Children's Hospital, Louisville, Kentucky, United States
,
Samir K. Gadepalli
9   Department of Surgery, C S Mott Children's Hospital, Ann Arbor, Michigan, United States
,
Julia Grabowski
10   Department of Pediatric Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
,
Edward Hernandez
11   Department of Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, United States
,
Ronald Hirschl
9   Department of Surgery, C S Mott Children's Hospital, Ann Arbor, Michigan, United States
,
Kevin N. Johnson
9   Department of Surgery, C S Mott Children's Hospital, Ann Arbor, Michigan, United States
,
Jonathan Kohler
12   Department of Surgery, University of Wisconsin Madison, Madison, Wisconsin, United States
,
Matthew P. Landman
11   Department of Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, United States
,
Rachel M. Landisch
13   Department of Surgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, United States
,
Amy E. Lawrence
2   Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Grace Z. Mak
14   Department of Surgery, University of Chicago Comer Children's Hospital, Chicago, Illinois, United States
,
Peter Minneci
15   Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Beth Rymeski
4   Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
,
Thomas T. Sato
13   Department of Surgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, United States
,
Bethany J. Slater
14   Department of Surgery, University of Chicago Comer Children's Hospital, Chicago, Illinois, United States
,
St. Shawn D. Peter
16   Department of Surgery, Center for Prospective Trials, Children's Mercy Hospital, Kansas City, Missouri, United States
› Author Affiliations

Abstract

Introduction Gastroschisis feeding practices vary. Standardized neonatal feeding protocols have been demonstrated to improve nutritional outcomes. We report outcomes of infants with gastroschisis that were fed with and without a protocol.

Materials and Methods A retrospective study of neonates with uncomplicated gastroschisis at 11 children's hospitals from 2013 to 2016 was performed.

Outcomes of infants fed via institutional-specific protocols were compared with those fed without a protocol. Subgroup analyses of protocol use with immediate versus delayed closure and with sutured versus sutureless closure were conducted.

Results Among 315 neonates, protocol-based feeding was utilized in 204 (65%) while no feeding protocol was used in 111 (35%). There were less surgical site infections (SSI) in those fed with a protocol (7 vs. 16%, p = 0.019). There were no differences in TPN duration, time to initial oral intake, time to goal feeds, ventilator use, peripherally inserted central catheter line deep venous thromboses, or length of stay. Of those fed via protocol, less SSIs occurred in those who underwent sutured closure (9 vs. 19%, p = 0.026). Further analyses based on closure timing or closure method did not demonstrate any significant differences.

Conclusion Across this multi-institutional cohort of infants with uncomplicated gastroschisis, there were more SSIs in those fed without an institutional-based feeding protocol but no differences in other outcomes.

Supplementary Material



Publication History

Received: 12 June 2020

Accepted: 12 October 2020

Article published online:
27 December 2020

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