Grace Centre for Newborn Intensive Care, The Children's Hospital of Westmead, Sydney, New South Wales, Australia.
Western Sydney University, Sydney, New South Wales, Australia.
J Paediatr Child Health. 2024 Nov;60(11):675-679. doi: 10.1111/jpc.16657. Epub 2024 Aug 29.
The primary objective of this study is to determine the impact of a standardised feeding protocol for infants with gastroschisis on early enteral feeds, suck feeds, management of gastric residuals and breastfeeding at discharge. Secondary objectives were evaluation of growth, length of stay in neonatal intensive care unit (NICU), the duration of total parental nutrition (TPN), blood-culture confirmed sepsis and serum bilirubin level (SBR).
This single-centre retrospective quality improvement project included infants admitted to a quaternary care NICU for management of gastroschisis from 2010 to 2021. The Gastroschisis feeding protocol, a standardised pathway for managing the feeding of infants with gastroschisis, was implemented in this NICU in 2016. The outcomes of infants in the pre-feeding protocol and post-feeding protocol groups were compared.
Of the 100 infants included in the study, 49 were in the post-feeding protocol group. The baseline characteristics of the study population did not differ statistically in both groups. In post-feeding protocol group, there was significant reduction in the time to the first enteral feed (P value <0.0001) and first suck feed (P value = 0.002). The median length of stay in the post-feeding protocol group was significantly lower by 11 days (P value = 0.001). Duration of TPN was 241 h higher in the pre-feeding protocol group (P value 0.0007).
Implementation of a feeding protocol in infants with gastroschisis led to earlier initiation of enteral feeds and suck feeds. There is a likelihood of reduction in the use of TPN and duration of admission in NICU.
本研究的主要目的是确定标准化喂养方案对先天性脐膨出患儿早期肠内喂养、吸吮喂养、胃残留管理和出院时母乳喂养的影响。次要目标是评估生长情况、新生儿重症监护病房（NICU）住院时间、全胃肠外营养（TPN）持续时间、血培养阳性败血症和血清胆红素水平（SBR）。
本单中心回顾性质量改进项目纳入 2010 年至 2021 年在一家四级护理 NICU 接受先天性脐膨出治疗的婴儿。该 NICU 于 2016 年实施了先天性脐膨出喂养方案，这是一种管理先天性脐膨出患儿喂养的标准化途径。比较了喂养前方案和喂养后方案组婴儿的结局。
在纳入研究的 100 名婴儿中，49 名婴儿在喂养后方案组。两组研究人群的基线特征在统计学上无差异。在喂养后方案组，首次肠内喂养（P<0.0001）和首次吸吮喂养（P=0.002）的时间明显缩短。喂养后方案组的中位住院时间明显缩短 11 天（P=0.001）。喂养前方案组 TPN 持续时间长 241 小时（P<0.0007）。
在先天性脐膨出患儿中实施喂养方案可更早开始肠内喂养和吸吮喂养。有可能减少 TPN 的使用和 NICU 住院时间。
