Abstract
BackgroundThe purpose of this study was to examine differences in attitudes to feeding in neonates with Gastroschisis between clinical groups and to develop a standardized feeding protocol. Confusion, inconsistencies in practice and lack of evidence could be contributing to avoidable delays in the establishment of enteral feeds resulting in lengthy requirements for central venous access, dependence on total parenteral nutrition (TPN), increased risk of sepsis, TPN related cholestasis and prolongation in length of hospital stay.MethodsA national survey of clinicians (neonatologists, neonatal intensive care nurses and paediatric surgeons), looking after neonates with gastroschisis was undertaken to determine differences in feeding practice post repair. In addition, an audit of practice in one hospital was undertaken to examine variations in practices between clinicians. A feeding protocol was then developed using inputs from surgeons and neonatologists.ResultsGastric aspirates and residuals were typically used as indicators of feed readiness and feed tolerance; however, there was very little consistency within and between clinical groups in definitions of tolerance or intolerance of feeds and in how to initiate and progress feeds. A feeding protocol with clear definition of feed readiness and a clear pathway to progression of feeds was developed to help overcome these variations in practice with the possibility that this might reduce the length of stay (LOS) and have other secondary benefits. The protocol included early introduction of enteral feeds particularly direct breast or sucking feeds.ConclusionsWide differences in attitudes to feeding neonates post Gastroschsis repair exist and the need for a consistent protocolized approach was felt. The feeding protocol we developed requires a change of practice and further clinical trials are needed to evaluate its effectiveness.
Highlights
The purpose of this study was to examine differences in attitudes to feeding in neonates with Gastroschisis between clinical groups and to develop a standardized feeding protocol
The delay in the establishment of enteral feeds often contributes to lengthy requirements for central venous access, dependence on total parenteral nutrition (TPN), small bowel bacterial overgrowth
When asked about the management of the volumes of gastric residuals the responses were varied with 44% stating aspirates should be discarded, 23% stating that only part of the aspirate should be returned and 9% stating that all of the aspirate should be returned
Summary
The purpose of this study was to examine differences in attitudes to feeding in neonates with Gastroschisis between clinical groups and to develop a standardized feeding protocol. Inconsistencies in practice and lack of evidence could be contributing to avoidable delays in the establishment of enteral feeds resulting in lengthy requirements for central venous access, dependence on total parenteral nutrition (TPN), increased risk of sepsis, TPN related cholestasis and prolongation in length of hospital stay. The delay in the establishment of enteral feeds often contributes to lengthy requirements for central venous access, dependence on total parenteral nutrition (TPN), small bowel bacterial overgrowth. Hobson et al BMC Pediatrics (2019) 19:475 For these reasons our aims were to examine differences in attitudes to feeding in neonates with Gastroschisis between clinical groups in Australia and to develop a standardized feeding protocol. The protocol would provide surgeons, neonatologists and neonatal nurses with a standardized feeding pathway with several secondary benefits such as earlier suck feeds and potentially an earlier discharge on breastfeeds, with the ultimate aim of improved feeding enhancing weight gain and improving infant physical and mental developmental outcomes
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