Dekonenko Charlene, Fraser Jason D, Deans Katherine, Fallat Mary E, Helmrath Michael, Kabre Rashmi, Leys Charles M, Burns R Cartland, Corkum Kristine, Dillon Patrick A, Downard Cynthia, Wright Tiffany N, Gadepalli Samir K, Grabowski Julia, Hernandez Edward, Hirschl Ronald, Johnson Kevin N, Kohler Jonathan, Landman Matthew P, Landisch Rachel M, Lawrence Amy E, Mak Grace Z, Minneci Peter, Rymeski Beth, Sato Thomas T, Slater Bethany J, Peter St Shawn D
Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States.
Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States.
Eur J Pediatr Surg. 2022 Apr;32(2):153-159. doi: 10.1055/s-0040-1721074. Epub 2020 Dec 27.
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.
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.
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%, = 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%, = 0.026). Further analyses based on closure timing or closure method did not demonstrate any significant differences.
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.
腹裂患儿的喂养方式各不相同。标准化的新生儿喂养方案已被证明可改善营养结局。我们报告了采用和未采用方案喂养的腹裂患儿的结局。
对2013年至2016年在11家儿童医院患有单纯性腹裂的新生儿进行了一项回顾性研究。将按照各机构特定方案喂养的婴儿的结局与未采用方案喂养的婴儿的结局进行比较。对立即闭合与延迟闭合以及缝合与非缝合闭合情况下方案使用情况进行了亚组分析。
在315名新生儿中，204名（65%）采用了基于方案的喂养，而111名（35%）未采用喂养方案。采用方案喂养的患儿手术部位感染（SSI）较少（7%对16%，P = 0.019）。在全胃肠外营养（TPN）持续时间、初次经口摄入时间、达到目标喂养时间、呼吸机使用、经外周静脉穿刺中心静脉置管深静脉血栓形成或住院时间方面没有差异。在采用方案喂养的患儿中，接受缝合闭合的患儿发生SSI的较少（9%对19%，P = 0.026）。基于闭合时间或闭合方法的进一步分析未显示任何显著差异。
在这个多机构队列的单纯性腹裂婴儿中，未采用基于机构的喂养方案喂养的患儿发生SSI的更多，但在其他结局方面没有差异。
