Feeding Intolerance and Poor Growth in Infants with Gastroschisis: Longitudinal Experience with Consecutive Patients over Thirteen Years

Objectives: 1) To investigate in-hospital factors associated with delayed tolerance of full volume enteral nutrition and 2) To assess longitudinal growth in a contemporary population of infants with gastroschisis. Design: Retrospective single-center study of all infants with gastroschisis Setting: Level III neonatal intensive care unit in a free-standing Children’s Hospital Duration: 13.5 years Materials & Methods: Detailed data regarding demographics, nutritional support, growth, and infant outcomes was collected for all infants with gastroschisis. Linear regression was used to investigate in-hospital factors associated with feeding intolerance and poor growth. Results: For 52 infants, the median gestational age at birth was 36 weeks, the median postnatal age to achieve full feeds was 22 days, and median in-hospital weight gain was 18 gm/day. With linear regression, there was a positive association between time to full feeds and both hospital length of stay (adjusted R2=0.503, p < 0.0001) and (unexpectedly) in-hospital weight gain (adjusted R2=0.125, p=0.0248). There was a negative association between in-hospital weight gain and preterm birth (adjusted R2=0.125, p=0.0356). For infants with longitudinal growth data, 35% had a weight < 5th percentile (of whom 67% were preterm). Conclusions: Many infants with gastroschisis have poor growth before and after hospital discharge. Aggressive feeding advancement may be a contributing factor to this finding and preterm infants may be at greater risk for poor growth than term infants.