Gastroschisis Feeding Protocol

Gastroschisis Feeding Protocol For infants with uncomplicated gastroschisis and birthweight > 1500 grams and > 34 weeks Replogle output < 20 ml/kg/day and > 48 hrs post-closure • Discontinue replogle • Start glycerin suppository 1 -2x/day Tolerance of D/C replogle for 24 hours? • Replace replogle to LCWS • Continue glycerin suppository • Re-attempt replogle removal when output < 20 ml/kg/day No Feeding Day 1 • Start 20 ml/kg breast milk PO/NG Q3H • Continue nonnutritive breast feeding • Encourage parents to feed 1 st bottle Yes Feeding Day 2 • Increase by 20 ml/kg/day PO/NG in 2 steps Feeding Day 3 • Increase by 20 ml/kg/day PO/NG in 2 steps • Begin nutritive breast feeding using sliding scale Feeding Day 4 • Increase by 20 ml/kg/day PO/NG in 2 steps Feeding Day 5 • Fortify feeds to 22 calories Continue increasing by 20 ml/kg/day until full feeds achieved What is intolerance?: • Retching • Ill-appearing • Forceful expulsion • Bilious emesis • Concerning abdominal exam (tenderness or change from prior) What is NOT intolerance? • Full belly • Small spit ups Intolerance Feeding Day 1: • Replace replogle • Re-attempt when output returns to < 20 ml/kg/day Intolerance Feeding Day 2+: • Decrease by 20 ml/kg • Continue glycerin • Re-attempt advancement in 12-24 hours Intolerance x3 attempts due to emesis: • Initiate continuous feeds at 20 ml/kg/day *Notify surgical fellow if intolerance develops Milk Type • If no mother ’s milk, use DBM + liquid protein • If DBM refused, use Elecare • When transitioning off DBM, first try Similac Total Comfort (non -WIC) or Goodstart Gentle (WIC) - if not tolerated, use Elecare Nonnutritive Breast Feeding: • Mom pumps < 30 min prior to putting infant to breast • Limit time to breast to < 30 min • Can initiate when replogle is in place Breast Feeding Sliding Scale: BF will be observed by LC on a regular basis to inform the amount of supplementation required Discharge: If > 38 weeks CGA and not increasing PO by 10% per week, follow G-tube algorithm Advancement: Consider removing NG & PO ad lib when taking 80%+ of goal feeds Discharge when taking oral feeds + weight gain x 48 hours