Got milk? Effects of early enteral feedings in patients with gastroschisis. 2015

Jennifer B Lemoine, and Rhonda R Smith, and Debra White
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).

BACKGROUND 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. OBJECTIVE To determine whether early nutritional management using a standardized advancement protocol improves outcomes for patients with gastroschisis. 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. CONCLUSIONS Consideration for future studies include incorporating strategies that combine early enteral feeding initiatives with interventions that allow for quicker onset of full enteral intake.

UI MeSH Term Description Entries
D007231 Infant, Newborn An infant during the first 28 days after birth. Neonate,Newborns,Infants, Newborn,Neonates,Newborn,Newborn Infant,Newborn Infants
D007234 Infant, Premature A human infant born before 37 weeks of GESTATION. Neonatal Prematurity,Premature Infants,Preterm Infants,Infant, Preterm,Infants, Premature,Infants, Preterm,Premature Infant,Prematurity, Neonatal,Preterm Infant
D007902 Length of Stay The period of confinement of a patient to a hospital or other health facility. Hospital Stay,Hospital Stays,Stay Length,Stay Lengths,Stay, Hospital,Stays, Hospital
D004750 Enteral Nutrition Nutritional support given via the alimentary canal or any route connected to the gastrointestinal system (i.e., the enteral route). This includes oral feeding, sip feeding, and tube feeding using nasogastric, gastrostomy, and jejunostomy tubes. Enteral Feeding,Force Feeding,Nutrition, Enteral,Tube Feeding,Gastric Feeding Tubes,Feeding Tube, Gastric,Feeding Tubes, Gastric,Feeding, Enteral,Feeding, Force,Feeding, Tube,Feedings, Force,Force Feedings,Gastric Feeding Tube,Tube, Gastric Feeding,Tubes, Gastric Feeding
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D015430 Weight Gain Increase in BODY WEIGHT over existing weight. Gain, Weight,Gains, Weight,Weight Gains
D015931 Intensive Care, Neonatal Continuous care and monitoring of newborn infants with life-threatening conditions, in any setting. Infant, Newborn, Intensive Care,Neonatal Intensive Care,Care, Neonatal Intensive
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D020139 Gastroschisis A congenital defect with major fissure in the ABDOMINAL WALL lateral to, but not at, the UMBILICUS. This results in the extrusion of VISCERA. Unlike OMPHALOCELE, herniated structures in gastroschisis are not covered by a sac or PERITONEUM. Congenital Fissure of the Abdominal Cavity,Gastroschises

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