University of Washington School of Medicine, Seattle, WA 98195, USA; Seattle Children's Hospital, Seattle, WA 98105, USA.
University of Washington School of Medicine, Seattle, WA 98195, USA.
J Pediatr Surg. 2022 Mar;57(3):356-359. doi: 10.1016/j.jpedsurg.2021.04.011. Epub 2021 Apr 19.
Infants with gastroschisis require prolonged hospitalization for surgical repair and gradual advancement of feeds. The present study explores the effect of a change in a protocolized enteral feeding regimen with length of hospital stay (LOS) and total costs in newborns with gastroschisis.
A retrospective review was performed in neonates with uncomplicated gastroschisis at a free-standing pediatric institution from 2012 to 2020. The effect of two different enteral feed advancement protocols on clinical outcomes and hospital costs was analyzed.
Seventy-four patients were identified, of which 50 (68%) underwent 10 ml/kg/day feeding advancements, and 24 (32%) underwent 20 ml/kg/day feeding advancements. Compared to neonates who underwent 10 ml/kg/day enteral advancements, neonates receiving 20 ml/kg/day advancements reached goal feeds faster (14 vs 20 days, p<0.001), were younger at goal feeds (26 vs 34 days, p = 0.001), required fewer days of parenteral nutrition (22 vs 29 days, p = 0.001), and had shorter LOS (30 vs 36 days, p = 0.001). On multivariable analysis, total costs decreased by 9.77% in the 20 ml/kg/day advancement cohort (p = 0.071).
In neonates with uncomplicated gastroschisis who underwent primary repair, a nutritional protocol that incorporated 20 ml/kg/day feeding advancements was safe and resulted in faster attainment of goal feeds and shorter LOS.
II/III.
患有先天性腹壁裂的婴儿需要长时间住院接受手术修复，并逐渐增加喂养量。本研究旨在探讨改变肠内喂养方案对新生儿先天性腹壁裂患者住院时间（LOS）和总费用的影响。
对 2012 年至 2020 年在一家独立的儿科机构接受治疗的单纯性先天性腹壁裂新生儿进行回顾性研究。分析了两种不同肠内喂养推进方案对临床结果和住院费用的影响。
共纳入 74 例患者，其中 50 例（68%）采用 10ml/kg/天喂养推进方案，24 例（32%）采用 20ml/kg/天喂养推进方案。与采用 10ml/kg/天肠内推进方案的新生儿相比，采用 20ml/kg/天肠内推进方案的新生儿更快达到目标喂养量（14 天 vs. 20 天，p<0.001），达到目标喂养量时年龄更小（26 天 vs. 34 天，p=0.001），需要的肠外营养天数更少（22 天 vs. 29 天，p=0.001），住院时间更短（30 天 vs. 36 天，p=0.001）。多变量分析显示，20ml/kg/天喂养推进组的总费用降低了 9.77%（p=0.071）。
在接受一期修复的单纯性先天性腹壁裂新生儿中，采用 20ml/kg/天喂养推进方案的营养方案是安全的，可更快地达到目标喂养量，并缩短 LOS。
II/III。
