Jennifer B Lemoine1, Rhonda R Smith, Debra White. 1. College of Nursing and Allied Health Professions, University of Louisiana at Lafayette, Lafayette, Louisiana (Dr Lemoine and Ms White); and Pediatrix Medical Group, Women's and Children's Hospital, Lafayette, Louisiana (Dr Lemoine and Ms Smith).
Abstract
BACKGROUND: Initiating early enteral intake post-surgical gastroschisis repair may result in better patient outcomes. However, there is lack of evidence and consistency in clinical practice regarding the timing of initiation of feedings, and few studies have determined best practices for post-operative nutritional management. PURPOSE: To determine whether early nutritional management using a standardized advancement protocol improves outcomes for patients with gastroschisis. FINDINGS/ RESULTS: A retrospective study was used, following the implementation of a new early enteral feeding protocol. Patients managed without the new protocol, from January 2007 through December 2009, formed the traditional feeding group, while those receiving post-protocol nutritional management, from January 2010 through December 2012, comprised the early enteral feeding group. The main outcome, measured by length of stay (LOS), and secondary outcomes, including incidence of sepsis, were evaluated; N = 32. There was a statistically significant difference in the scores for LOS (P = .022) and incidence of sepsis (P = .36). No correlation was found between the number of days to initial feeding and LOS (P = .732). However, there was a robust, positive correlation between the number of days to achieve full feedings and LOS (P < .001) IMPLICATIONS FOR PRACTICE: These findings support the benefit of early initiation of enteral feedings in reducing the incidence of sepsis. Furthermore, they suggest the time to achieve full enteral feedings, not necessarily the timing of initiation of feedings, significantly impacts LOS. IMPLICATIONS FOR RESEARCH: Consideration for future studies include incorporating strategies that combine early enteral feeding initiatives with interventions that allow for quicker onset of full enteral intake.
BACKGROUND: Initiating early enteral intake post-surgical gastroschisis repair may result in better patient outcomes. However, there is lack of evidence and consistency in clinical practice regarding the timing of initiation of feedings, and few studies have determined best practices for post-operative nutritional management. PURPOSE: To determine whether early nutritional management using a standardized advancement protocol improves outcomes for patients with gastroschisis. FINDINGS/ RESULTS: A retrospective study was used, following the implementation of a new early enteral feeding protocol. Patients managed without the new protocol, from January 2007 through December 2009, formed the traditional feeding group, while those receiving post-protocol nutritional management, from January 2010 through December 2012, comprised the early enteral feeding group. The main outcome, measured by length of stay (LOS), and secondary outcomes, including incidence of sepsis, were evaluated; N = 32. There was a statistically significant difference in the scores for LOS (P = .022) and incidence of sepsis (P = .36). No correlation was found between the number of days to initial feeding and LOS (P = .732). However, there was a robust, positive correlation between the number of days to achieve full feedings and LOS (P < .001) IMPLICATIONS FOR PRACTICE: These findings support the benefit of early initiation of enteral feedings in reducing the incidence of sepsis. Furthermore, they suggest the time to achieve full enteral feedings, not necessarily the timing of initiation of feedings, significantly impacts LOS. IMPLICATIONS FOR RESEARCH: Consideration for future studies include incorporating strategies that combine early enteral feeding initiatives with interventions that allow for quicker onset of full enteral intake.