How do you feed patients after gastroschisis repair?

Infographic · Oct 2021 · 1 min read

In brief

This meta-analysis of eight studies demonstrates that standardized feeding protocols after gastroschisis repair enable earlier initiation of enteral feeding (3.19 days sooner) with reduced complications and mortality compared to non-protocolized approaches. While trends suggest shorter parenteral nutrition duration and hospital stays, these differences were not statistically significant, indicating need for prospective randomized trials.

Standardized feeding protocols after gastroschisis repair initiate enteral feeding 3.19 days earlier than non-protocolized approaches (p<0.0001).
Protocolized feeding is associated with reduced complication rates, lower mortality, and better compliance to postoperative care.
Time to full enteral feeding and duration of parenteral nutrition showed improvement trends but were not statistically significant.
Meta-analysis of 8 cohort studies (2000-2019) suggests protocolized feeding may reduce sepsis rates and shorten hospital stays.
Prospective randomized trials are needed to definitively establish optimal feeding protocols for gastroschisis repair patients.

Written by the GCMD Library team from the infographic.

Teal-colored infographic with white text boxes arranged in a layout featuring icons of a baby bottle, IV bag, documents, clock, and data charts. Key finding highlighted in large red text. Cincinnati Children's and Pediatric Surgery logos appear at bottom right.

Abstract

Background

Improved post-operative outcomes following gastroschisis repair are attributed to advancement in perioperative and post-operative care and early enteral feeding. This study evaluates the role of standardized postoperative feeding protocols in gastroschisis.

Study design

A systematic review and meta-analysis of studies published from January 2000 to April 2019 in MEDLINE, EMBASE, Cochrane Library databases and Google Scholar was conducted. Primary outcomes were duration to full enteral feeding and cessation of parenteral nutrition. Secondary outcomes included days to first enteral feeding, length of stay, compliance, complication and mortality rates. Meta-analysis was done using the RevMan Analysis Statistical Package in Review Manager (Version 5.3) using a random effects model and reported as pooled Risk Ratio and Mean Difference. p-value < 0.05 was considered statistically significant.

Results

Eight observational cohort studies were identified and their data analyzed. Significant heterogeneity was noted for some outcomes. Standardized feeding protocols resulted in fewer days to first enteral feeding by 3.19 days (95% CI: -4.73, -1.66, p < 0.0001) than non-protocolized feeding, less complication rates, reduced mortality and better compliance to care. The duration of parenteral nutrition and time to full enteral feeding were not significantly affected.

Conclusion

Protocolized feeding post-gastroschisis repair is associated with early initiation of enteral feeding. There is a likelihood of reduced rates of sepsis; shorter duration of parenteral nutrition, length of hospital stay and time to full enteral feeding. However, the latter trends are not statistically significant and will require further studies best accomplished with a prospective randomized trial or more cohort studies.

Keywords

The text in the image

How do you feed patients after gastroschisis repair? | Systematic review and meta-analysis of studies published Jan 2000 to April 2019 | Total of 8 observational cohort studies comparing outcomes of gastroschisis-specific feeding protocol to non protocolized feeding identified and analyzed | Standardized feeding protocols associated with: | time to first enteral feeds by 3.19 days (p<0.0001) | Standardized feeding protocols post gastroschisis-repair is linked to earlier enteral feeding and may improve other post operative outcomes too | Raduma et al. DOI: 10.1016/j.jpedsurg.2021.05.022 | StayCurrent INFOGRAPHICS | Cincinnati Children's | Pediatric Surgery

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