Feeding Practice, Nutrition, and Growth in Infants with Abdominal Wall Defects and Esophageal Atresia: A Retrospective Case–Control Study

Abstract

Introduction Infants born with abdominal wall defects and esophageal atresia (EA) are at risk of impaired growth. Little is known about the optimal nutritional strategy and its impact on growth for these infants. This study aims to explore nutrition, focusing on breastfeeding, and the presumed impact on infant growth during the first year of life.

Materials and Methods We performed a registry study. The participants comprised infants born with gastroschisis, omphalocele, or EA from 2009 to 2020. Breastfed healthy infants from the Odense Child Cohort served as the control group. Descriptive statistics were applied when presenting data on nutrition. Growth data were converted to weight z-scores at birth and at discharge, and estimated weight z-scores at 6 and 12 months were calculated. Univariate regression analysis was applied.

Results The study included 168 infants in the study group and 403 infants in the control group. Exclusive breastfeeding rates at discharge were as follows: 55.7% (gastroschisis), 58.3% (omphalocele), 50.9% (EA), and 7.7% (long-gap EA). For the study group our data demonstrate no difference in growth at 1 year of age when comparing mother's milk to formula feeding. During the first year of life, infants in the study group showed slower growth compared with the control group. At 12 months of age, all infants had a mean weight z-score above –2.

Conclusion Breastfeeding in infants with abdominal wall defects and EA can be established without compromising growth. Mother's milk can be recommended for infants with abdominal wall defects and EA.

Keywords

congenital abdominal wall defect - esophageal atresia - breastfeeding - growth

Publication History

Received: 11 April 2022

Accepted: 23 August 2022

Article published online:
31 December 2022

• References

• 1 Escobar Jr MA, Caty MG. Complications in neonatal surgery. Semin Pediatr Surg 2016; 25 (06) 347-370
• 2 Traini I, Menzies J, Hughes J, Leach ST, Krishnan U. Oesophageal atresia: the growth gap. World J Gastroenterol 2020; 26 (12) 1262-1272
• 3 Bairdain S, Zurakowski D, Vargas SO. et al. Long-gap esophageal atresia is a unique entity within the esophageal atresia defect spectrum. Neonatology 2017; 111 (02) 140-144
• 4 Foker JE, Linden BC, Boyle Jr EM, Marquardt C. Development of a true primary repair for the full spectrum of esophageal atresia. Ann Surg 1997; 226 (04) 533-541 , discussion 541–543
• 5 Oluwafemi OO, Benjamin RH, Navarro Sanchez ML. et al. Birth defects that co-occur with non-syndromic gastroschisis and omphalocele. Am J Med Genet A 2020; 182 (11) 2581-2593
• 6 Gamba P, Midrio P. Abdominal wall defects: prenatal diagnosis, newborn management, and long-term outcomes. Semin Pediatr Surg 2014; 23 (05) 283-290
• 7 Varma S, Bartlett EL, Nam L, Shores DR. Use of breast milk and other feeding practices following gastrointestinal surgery in infants. J Pediatr Gastroenterol Nutr 2019; 68 (02) 264-271
• 8 Baerg JE, Munoz AN. Long term complications and outcomes in omphalocele. Semin Pediatr Surg 2019; 28 (02) 118-121
• 9 Bhat V, Moront M, Bhandari V. Gastroschisis: a state-of-the-art review. Children (Basel) 2020; 7 (12) 7
• 10 Hong CR, Zurakowski D, Fullerton BS, Ariagno K, Jaksic T, Mehta NM. Nutrition delivery and growth outcomes in infants with gastroschisis. JPEN J Parenter Enteral Nutr 2018; 42 (05) 913-919
• 11 Fitzgerald DA, Kench A, Hatton L, Karpelowsky J. Strategies for improving early nutritional outcomes in children with oesophageal atresia and congenital diaphragmatic hernia. Paediatr Respir Rev 2018; 25: 25-29
• 12 Salvatori G, Foligno S, Occasi F. et al. Human milk and breastfeeding in surgical infants. Breastfeed Med 2014; 9 (10) 491-493
• 13 Hennet T, Borsig L. Breastfed at Tiffany's. Trends Biochem Sci 2016; 41 (06) 508-518
• 14 World Health Organization. World Health Organization. Guideline: Assessing and Managing Children at Primary Health-Care Facilities to Prevent Overweight and Obesity in the Context of the Double Burden of Malnutrition: Updates for the Integrated Management of Childhood Illness (IMCI) Web site. Accessed January 18, 2022, at: https://www.who.int/publications/i/item/9789241550123
• 15 Nilsson I, Busck-Rasmussen M. Amning - en håndbog for sundhedspersonale. 5th ed. København: Sundhedsstyrelsen; 2021
• 16 Bruun S, Buhl S, Husby S. et al. Breastfeeding, infant formula, and introduction to complementary foods-comparing data obtained by questionnaires and health visitors' reports to weekly short message service text messages. Breastfeed Med 2017; 12 (09) 554-560
• 17 Maastrup R, Hansen BM, Kronborg H. et al. Breastfeeding progression in preterm infants is influenced by factors in infants, mothers and clinical practice: the results of a national cohort study with high breastfeeding initiation rates. PLoS One 2014; 9 (09) e108208
• 18 Riddle S, Haberman B, Miquel-Verges F. et al. Gastroschisis with intestinal atresia leads to longer hospitalization and poor feeding outcomes. J Perinatol 2022; 42 (02) 254-259
• 19 Salvatori G, Foligno S, Massoud M, Piersigilli F, Bagolan P, Dotta A. The experience of breastfeeding infants affected by congenital diaphragmatic hernia or esophageal atresia. Ital J Pediatr 2018; 44 (01) 75
• 20 Tucker A, Huang EY, Peredo J, Weems MF. Pilot study of sham feeding in postoperative neonates. Am J Perinatol 2022; 39 (07) 726-731
• 21 Kyhl HB, Jensen TK, Barington T. et al. The Odense Child Cohort: aims, design, and cohort profile. Paediatr Perinat Epidemiol 2015; 29 (03) 250-258
• 22 Lee PA, Chernausek SD, Hokken-Koelega AC, Czernichow P. International Small for Gestational Age Advisory Board. International Small for Gestational Age Advisory Board consensus development conference statement: management of short children born small for gestational age, April 24-October 1, 2001. Pediatrics 2003; 111 (6 Pt 1): 1253-1261
• 23 Niklasson A, Albertsson-Wikland K. Continuous growth reference from 24th week of gestation to 24 months by gender. BMC Pediatr 2008; 8: 8
• 24 Hijkoop A, Peters NCJ, Lechner RL. et al. Omphalocele: from diagnosis to growth and development at 2 years of age. Arch Dis Child Fetal Neonatal Ed 2019; 104 (01) F18-F23
• 25 Moro GE, Arslanoglu S, Bertino E. et al; American Academy of Pediatrics; European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. XII. Human milk in feeding premature infants: consensus statement. J Pediatr Gastroenterol Nutr 2015; 61 (Suppl 1): S16-S19
• 26 Leibovitch L, Zohar I, Maayan-Mazger A, Mazkereth R, Strauss T, Bilik R. Infants born with esophageal atresia with or without tracheo-esophageal fistula: short- and long-term outcomes. Isr Med Assoc J 2018; 20 (03) 161-166
• 27 Tenovuo A, Kero P, Piekkala P, Korvenranta H, Sillanpää M, Erkkola R. Growth of 519 small for gestational age infants during the first two years of life. Acta Paediatr Scand 1987; 76 (04) 636-646
• 28 Minutillo C, Rao SC, Pirie S, McMichael J, Dickinson JE. Growth and developmental outcomes of infants with gastroschisis at one year of age: a retrospective study. J Pediatr Surg 2013; 48 (08) 1688-1696
• 29 Pelizzo G, Destro F, Selvaggio GGO. et al. Esophageal atresia: nutritional status and energy metabolism to maximize growth outcome. Children (Basel) 2020; 7 (11) 7
• 30 Mason SJ, Harris G, Blissett J. Tube feeding in infancy: implications for the development of normal eating and drinking skills. Dysphagia 2005; 20 (01) 46-61
• 31 Vergouwe FWT, Spoel M, van Beelen NWG. et al. Longitudinal evaluation of growth in oesophageal atresia patients up to 12 years. Arch Dis Child Fetal Neonatal Ed 2017; 102 (05) F417-F422
• 32 Gulack BC, Laughon MM, Clark RH. et al. Enteral feeding with human milk decreases time to discharge in infants following gastroschisis repair. J Pediatr 2016; 170: 85-89