J. C. Harris1, J. Poirier1, D. Selip2, S. Pillai1, A. N. Shah1, C. Jackson3, B. Chiu1 1Rush University Medical Center,General Surgery,Chicago, IL, USA 2Rush University Medical Center Fetal And Neonatal Medicine Center,Pediatrics,Chicago, IL, USA 3Tufts Medical Center,Pediatric Surgery,Boston, MA, USA
Introduction: Gastroschisis is a congenital anomaly affecting 1-6/10,000 live births. Return of bowel function after closure and time to initiation of enteral feeds are highly variable. Previous studies show initiation of enteral feeds within 7 days after closure decreases hospital stay and predicts improved outcomes. This study aims to identify factors associated with initiation of earlier enteral feeds. We hypothesize that post-natal management strategies that minimize intestinal irritation can lead to earlier enteral feed initiation.
Methods: A retrospective review of patients with gastroschisis treated between 2005-2014 at a single institution was performed. Data points included: mother’s age, ethnicity, simple versus complex gastroschisis (defined by necrosis, atresia, or volvulus), gestational age, gender, ventilator days, length of stay, mortality, days to closure, time to first and full enteral feeds. The data were analyzed using both Spearman’s rho and the Kruskal-Wallis rank sum test where appropriate, and p value <0.05 was considered significant.
Results: The charts of 43 patients (24 males, 19 females) born with gastroschisis were reviewed. 7 out of 43 were classified as complex gastroschisis. Average gestational age at delivery was 35 weeks (28-39 weeks). Overall survival rate was 88% (38/43). The mean hospitalization was 88 days (0-498 days). Average maternal age was 19.5 years. Maternal race was 35% Hispanic, 33% Caucasian, 30% African American, and 2% American Indian. Average days on the ventilator were 12.9 days. 5 patients were closed on day of life (DOL) 0. Mean days to closure were 7.3 (0 to 85) days. First feeds, on average began DOL 20.5, and full feeds achieved on day 35.1. If closed before DOL 5, first feed was intiated on average DOL 13; if closed after DOL 5, feeds began on DOL 28.
Average birth weight was 2620 grams. This did not correlate with the time to definitive closure of the gastroschisis (p=0.6) nor was there an association with time to first feeding (p=0.52). Additionally, time to first feeds was not significantly different among ethnic groups (p=0.42), but there was a possible trend when analyzing time to definitive closure of the gastroschisis between ethnic groups (p=0.073). However, early closure of gastroschisis was correlated with early initiation of feeds (p=0.0001) and shorter time to full feeds (p=0.04).
Conclusion: Early closure of gastroschisis was associated with early feed initiation and shorter time to full feeds. Returning bowel into the abdominal cavity sooner may minimize intestinal irritation, leading to earlier return of bowel function. Based on these findings, early definitive closure may improve the outcome of patients with gastroschisis.
