Association of Exclusive Breast Milk Intake and Outcomes in Infants With Uncomplicated Gastroschisis: A National Cohort Study
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New article review by Alex Halpern, MD!
Full text: https://www.jpedsurg.org/article/S0022-3468(24)00077-0/fulltext
Background: Enteral feeding is an essential part of the management of infants with gastroschisis. We hypothesized that exclusive breast milk is associated with improved neonatal outcomes.
Methods: We conducted a retrospective review of infants with uncomplicated gastroschisis through the Canadian Pediatric Surgery Network (CAPSNet) and Canadian Neonatal Network (CNN). The primary outcome was time to full enteral feeds.
Results: We identified 411 infants with gastroschisis treated at CAPSNet centres from 2014 to 2022. 144 patients were excluded due to gestational age <32 weeks, birth weight <1500 g, other congenital anomalies, or complicated gastroschisis. Of the remaining 267 participants, 78% (n = 209) received exclusive breast milk diet in the first 28 days of life, whereas 22% (n = 58) received supplemental or exclusive formula. Infants who received exclusive breast milk experienced higher time to reach full enteral feeding (median 24 vs 22 days, p = 0.047) but were more likely to have undergone delayed abdominal closure (32% vs 17%, p = 0.03). After adjustment, there were no significant differences between groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay. Infants who received supplemental or exclusive formula had a similar risk of necrotizing enterocolitis (4% vs 3%) but were less likely to transition to exclusive breast milk at discharge (73% vs 11%, p < 0.001).
Conclusion: Early use of exclusive breast milk in infants with uncomplicated gastroschisis is associated with similar outcomes compared to supplemental or exclusive formula. Patients who received supplemental or exclusive formula were unlikely to transition to exclusive breastfeeding by discharge.
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Does exclusive breast milk intake affect outcomes and uncomplicated gastroschisis? I'm Alex Halpern, general surgery resident from George Washington University working with Cincinnati Children's, and this is an article that you should know. The team at McMaster University performed a retrospective review looking at infants born between 2014 and 2022 with uncomplicated gastroschisis to try to answer this question. They found that the infants with exclusive breast milk intake and the ones with supplemental or exclusive formula intake had similar outcomes, with no significant differences between the groups in time to reach full enteral feeds, duration of parenteral nutrition, rates of necrotizing enterocolitis. And length of stay in the hospital. So it seems like formula intake versus exclusive breast milk intake does not really affect outcomes in uncomplicated gastroschisis. Does this information change your practice at all? Let us know what you think in the comments below.