670 - Longitudinal Cohort Study of Feeding and Nutrition Outcomes in Infants with Complex Gastroschisis with Atresia from Birth to 2 years of age

Publication Number: 1647.670

Apthi C. Muralidhar, Baylor College of Medicine, Bellaire, TX, United States; Amy B. Hair, Baylor College of Medicine, Houston, TX, United States; Elena Itriago, Baylor College of Medicine, Houston, TX, United States

Background: Infants with complex gastroschisis (gastroschisis associated with perforation, volvulus, or atresia) have increased complications both during hospitalization and post-discharge. Despite the serious implications, nutrition and feeding outcomes in infants with complex gastroschisis from birth to 2 years of age have not been thoroughly investigated.

Objective: This study aims to identify treatment trends, nutritional outcomes, and both short- and long-term outcomes for infants with complex gastroschisis.

Design/Methods: A retrospective cohort study was conducted at a large quaternary NICU evaluating infants diagnosed with gastroschisis and atresia from 2014 to 2023. Outcomes were assessed related to the development of intestinal failure, duration of hospitalization, complications associated with intestinal failure, and nutritional outcomes. Patients were categorized based on the type of intestinal atresia, while those who transferred to another facility, and those who did not survive their NICU hospitalization were excluded from analysis.

Results: Sixteen infants with complex gastroschisis and atresia were analyzed. One patient was excluded due to transfer, and two patients died during hospitalization. Types of atresia diagnoses varied (Table 1). Key outcomes included the development of intestinal failure in 7 infants, 3 instances of necrotizing enterocolitis, and 13 cases of cholestasis. The mean duration of parenteral nutrition (PN) was 133 ± 72 days, with 7 infants requiring home PN. Feeds were initiated after a mean of 67 ± 31 days, and 9 infants achieved enteral autonomy during hospitalization, requiring an average of 48 ± 41 days to reach full feeds. At discharge, feeding methods varied, with 3 infants receiving exclusively breast milk or formula and 10 receiving a combination. Follow-up data at 2 years showed 37.5% of patients dependent on PN. Within 2 years after discharge, complications included 5 infections related to central lines, 1 case of cholestasis, and 4 instances of bacterial overgrowth.

Conclusion(s): Infants with complex gastroschisis exhibit significant feeding challenges and complications during their initial hospitalization. Overall, 44% of infants were discharged home on PN; however 37% remained PN-dependent at two years of age, indicating prolonged intestinal failure. This study offers important insights into postnatal treatment, as well as short- and long-term outcomes until 2 years of age, which can inform counseling and anticipatory guidance for families navigating these complexities.

Table 1. Baseline Demographics and Clinical Characteristics
1. Mean ± Standard Deviation
2. Median (Interquartile range)
3. Frequency (%)

Table 2. Nutritional Characteristics
1. Mean ± Standard Deviation 
2. Median (Interquartile range) 
3. Frequency (%) 
PN: parenteral nutrition

Table 3. NICU Discharge Clinical and Nutritional Outcomes
1. Mean ± Standard Deviation 
2. Median (Interquartile range) 
3. Frequency (%) 
PN: parenteral nutrition