The effect of standardized feeding protocol on early outcome following gastroschisis repair: A systematic review and meta-analysis
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Gastroschisis
Enteral administration
Nutrition practices for preterm infants during the first few weeks of life can be divided into three phases: the parenteral nutrition (PN), enteral nutrition (EN), and transition (TN) phases; the TN phase includes both PN and EN. Our purpose was to analyze nutrition practices for very preterm infants during the TN phase and their association with the infants' growth during the first 28 days of life.Data from 268 very preterm infants <32 weeks old from six neonatal intensive care units were analyzed retrospectively. The TN phase was defined as enteral feedings of 30-120 ml/kg/d. Postnatal growth failure (PGF) was defined as a 28-day growth velocity <15 g/kg/d. Differences in protein and energy intake between the PGF and non-PGF groups during the TN phase were calculated, and risk factors for PGF were identified using multivariate regression analysis.The total protein (parenteral + enteral) intake during the TN was 3.16 (2.89, 3.47) g/kg/d, which gradually decreased as the enteral feeding volume increased in the TN phase. The total energy (parenteral + enteral) intake during the TN phase was 115.72 (106.98, 122.60) kcal/kg/d. The PGF group had a lower total protein intake (parenteral + enteral) than the non-PGF group had [3.09 (2.85, 3.38) g/kg/d vs. 3.27 (3.06, 3.57) g/kg/d, P = 0.007, respectively]. No significant difference was found in energy intake during the TN phase. The variables associated with PGF included a lower total protein (parenteral + enteral) intake, a smaller day of age at the end of the TN phase, and a higher birth weight z-score.Increasing the total protein intake (parenteral + enteral) during the TN could reduce the incidence of PGF.
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Total Parenteral Nutrition (TPN), which uses intravenous administration of nutrients, minerals and vitamins, is essential in sustaining premature infants until they transition to enteral feeds. There is limited information on metabolomic differences between infants on TPN and enteral feeds. We performed untargeted global metabolomics on urine samples collected between 23-30 days of life from 314 infants born &lt;29 weeks gestational age from the TOLSURF and PROP cohorts. Principal component analysis across all metabolites showed a separation of infants solely on TPN as compared to infants who had transitioned to enteral feeds, indicating global metabolomic differences between infants based on feeding status. Among 913 metabolites that passed quality control filters, 609 varied in abundance between infants on TPN vs enteral feeds at p&lt;0.05. Of these, 88% were in the direction of higher abundance in the urine of infants on enteral feeds. In a subset of infants with longitudinal analysis, both concurrent and delayed changes in metabolite levels were observed with initiation of enteral feeds. Infants on enteral feeds had higher concentrations of essential amino acids, lipids, and vitamins, which are necessary for growth and development, suggesting a nutritional benefit of an enteral feeding regimen.
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Total Parenteral Nutrition (TPN), which uses intravenous administration of nutrients, minerals and vitamins, is essential for sustaining premature infants until they transition to enteral feeds, but there is limited information on metabolomic differences between infants on TPN and enteral feeds. We performed untargeted global metabolomics on urine samples collected between 23–30 days of life from 314 infants born <29 weeks gestational age from the TOLSURF and PROP cohorts. Principal component analysis across all metabolites showed a separation of infants solely on TPN compared to infants who had transitioned to enteral feeds, indicating global metabolomic differences between infants based on feeding status. Among 913 metabolites that passed quality control filters, 609 varied in abundance between infants on TPN vs. enteral feeds at p < 0.05. Of these, 88% were in the direction of higher abundance in the urine of infants on enteral feeds. In a subset of infants in a longitudinal analysis, both concurrent and delayed changes in metabolite levels were observed with the initiation of enteral feeds. These infants had higher concentrations of essential amino acids, lipids, and vitamins, which are necessary for growth and development, suggesting the nutritional benefit of an enteral feeding regimen.
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Gastroschisis is an abdominal wall defect typically located to the right of the umbilical cord in which intestines and occasionally other abdominal contents herniate through the abdominal wall opening. The etiology of this defect is unknown. The increased recurrence risks observed in families with a child with gastroschisis suggest that genetic factors play a role in its causation. However, non-genetic factors are also important, as evidenced by the increased occurrence of gastroschisis among younger mothers, the increasing prevalence of gastroschisis in recent years observed by several birth defects surveillance systems, and the frequent occurrence of gastroschisis in a cluster pattern. Despite recognition of the importance of non-genetic factors in gastroschisis causation, no factors, other than young maternal age, have been definitively identified, limiting the development of prevention strategies. This article summarizes the currently available literature on non-genetic risk factors for gastroschisis, including investigations of sociodemographic factors, maternal therapeutic medication and non-therapeutic drug exposures, chemical exposures, and other factors. The article also discusses some of the challenges faced by investigators working to better understand gastroschisis etiology.
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Infants born with gastroschisis in association with intestinal atresia are well described. We are the proposing the classification of vanishing gastroschisis. In this series of six cases, at one end of the spectrum is an infant having gastroschisis with a much narrower defect on the right side of umbilicus. The ischemic bowel loops were connected to bowel inside the abdomen by a fibrous band compressing the exposed bowel mesentery. On the other end of spectrum, an infant having extensive bowel atresia and complete closure of abdominal wall defect (gastroschisis) detected on antenatal ultrasound. These cases should raise awareness of this devastating complication in prenatal management of gastroschisis.
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Intestinal atresia
Abdominal wall defect
Short Bowel Syndrome
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Gastroschisis, is a prevalently encountered congenital disease of the newborns where intraabdominal organs protrude through a full-thickness defect in the anterior abdominal wall without an overlying sac. In recent years, an increase in the global incidence of gastroschisis has been reported. Although its etiology is not known fully, it is usually associated with young maternal age. Delay in the transition to full-calorie enteral feeding (ENT) in a newborn with gastroschisis is a result of bowel dysfunction which is a major morbidity developing due to exposure of bowels to amniotic fluid. Consequently, newborn may require long-term TPN treatment, and sepsis may onset secondary to prolonged mechanical ventilation, and TPN treatment, and infection,. Global incidence of congenital hypothyroidism (CH) in live births is 1:3000-4000. Widely encountered symptoms may include prolonged jaundice, constipation, distended abdomen, and poor feeding. The diagnosis should be confirmed by finding an elevated serum TSH and low T4 or free T4 level. In the literature, transient hypothyroidism has been reported in cases who underwent only silo operation, and povidone iodine dressings,. Association of hypothyroidism with delayed transition to full enteral feeding, and prolonged hospital stay in gastroschisis has not been reported previously. In newborns with gastroschisis who underwent primary facial repair, thyroid functions should be controlled at appropriate times, and followed up closely.
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To examine the aluminum content of several commercially available enteral nutrition formulas and parenteral solutions.Twelve enteral nutrition formulas and 10 parenteral solutions were commonly used in routine clinical care of patients and obtained from different medical companies in Turkey. The aluminum contents were determined by electrothermal atomic absorption spectrophotometry.We found that aluminum concentration in the enteral nutrition formulas and the parenteral solutions to range from 87.6 to 961.2 ng/mL and 58.4 to 1232.0 ng/mL, respectively.Careful clinical and biochemical monitoring are warranted to determine whether it will be necessary to eliminate aluminum contamination of enteral and parenteral preparations used in patients, particularly infants, with reduced kidney function who may be at risk for aluminum intoxication.
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INTRODUCTION: Gastroschisis is a congenital abdominal wall defect associated with complications such as cesarean delivery (CD). Previous studies have reported greater than 30% of these pregnancies having fetal intolerance of labor (FIOL). We sought to characterize obstetric factors associated with gastroschisis. METHODS: Population-based retrospective cohort study of livebirths in Ohio (2006-2015). Frequency of gastroschisis was obtained from birth certificate data. Obstetric characteristics were compared between women who delivered an infant with gastroschisis compared to those who without gastroschisis. Multivariate logistic regression estimated the influence of gastroschisis on the outcomes of FIOL and CD. RESULTS: Of 1,428,125 live births in Ohio during the 10-year study period, 620 (0.04%) women delivered an infant with a isolated gastroschisis. The CD rate was 45.7% vs 31.0% (p<0.001) in women who delivered an infant with gastroschisis compared to those without gastroschisis. Among women who were induced, the rate of FIOL was 13.4% vs 10.3% (p=0.145) in gastroschisis compared to non-gastroschisis pregnancies respectively. After adjusted analysis, women with gastroschisis pregnancies were not more likely to have FIOL (aOR 0.9, 95% CI 0.6-1.2) compared to those without gastroschisis. Among women who underwent CD, 79.4% (n=181/228) had a primary CD without a trial of labor despite being vertex. CONCLUSION: We did not find an association of intrapartum FIOL in gastroschisis pregnancies. Less than 15% of pregnancies with gastroschisis are complicated by FIOL despite having a higher rate and association with CD. Elective CD should be avoided in pregnancies with gastroschisis given the known maternal morbidity and lack of neonatal benefit.
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Abdominal wall defect
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Malondialdehyde
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In 1996-2000 yrs 20 children with gastroschisis were operated, of whom 9 died. Tactics of application of general anesthesy in conjunction with spinal and caudal anesthesy, permitting to lower mortality of newborn children with gastroschisis, was enlightened.
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