Lemoine Jennifer B, Smith Rhonda R, White Debra
College of Nursing and Allied Health Professions, University of Louisiana at Lafayette, Lafayette, Louisiana (Dr Lemoine and Ms White); and Pediatrix Medical Group, Women's and Children's Hospital, Lafayette, Louisiana (Dr Lemoine and Ms Smith).
Adv Neonatal Care. 2015 Jun;15(3):166-75. doi: 10.1097/ANC.0000000000000171.
Initiating early enteral intake post-surgical gastroschisis repair may result in better patient outcomes. However, there is lack of evidence and consistency in clinical practice regarding the timing of initiation of feedings, and few studies have determined best practices for post-operative nutritional management.
To determine whether early nutritional management using a standardized advancement protocol improves outcomes for patients with gastroschisis.
FINDINGS/RESULTS: A retrospective study was used, following the implementation of a new early enteral feeding protocol. Patients managed without the new protocol, from January 2007 through December 2009, formed the traditional feeding group, while those receiving post-protocol nutritional management, from January 2010 through December 2012, comprised the early enteral feeding group. The main outcome, measured by length of stay (LOS), and secondary outcomes, including incidence of sepsis, were evaluated; N = 32. There was a statistically significant difference in the scores for LOS (P = .022) and incidence of sepsis (P = .36). No correlation was found between the number of days to initial feeding and LOS (P = .732). However, there was a robust, positive correlation between the number of days to achieve full feedings and LOS (P < .001) IMPLICATIONS FOR PRACTICE: These findings support the benefit of early initiation of enteral feedings in reducing the incidence of sepsis. Furthermore, they suggest the time to achieve full enteral feedings, not necessarily the timing of initiation of feedings, significantly impacts LOS.
Consideration for future studies include incorporating strategies that combine early enteral feeding initiatives with interventions that allow for quicker onset of full enteral intake.
在先天性腹裂修补术后尽早开始肠内营养摄入可能会带来更好的患者预后。然而，在临床实践中，关于开始喂养的时机缺乏证据且存在不一致性，很少有研究确定术后营养管理的最佳实践。
确定使用标准化推进方案的早期营养管理是否能改善先天性腹裂患者的预后。
采用回顾性研究，在实施新的早期肠内喂养方案之后进行。2007年1月至2009年12月未采用新方案进行管理的患者组成传统喂养组，而2010年1月至2012年12月接受方案后营养管理的患者组成早期肠内喂养组。评估了以住院时间（LOS）衡量的主要结局以及包括败血症发生率在内的次要结局；N = 32。LOS评分（P = 0.022）和败血症发生率（P = 0.36）存在统计学显著差异。未发现初次喂养天数与LOS之间存在相关性（P = 0.732）。然而，达到全量喂养的天数与LOS之间存在强烈的正相关（P < 0.001）
这些发现支持了早期开始肠内喂养在降低败血症发生率方面的益处。此外，它们表明达到全量肠内喂养的时间，而非开始喂养的时间，对LOS有显著影响。
未来研究的考虑因素包括纳入将早期肠内喂养举措与能使全量肠内摄入更快开始的干预措施相结合的策略。
