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Use of Breast Milk and Other Feeding Practices Following Gastrointestinal Surgery in Infants

Varma, Sanskriti*; Bartlett, Edward L.; Nam, Lucy*; Shores, Darla R.

Journal of Pediatric Gastroenterology and Nutrition: February 2019 - Volume 68 - Issue 2 - p 264–271
doi: 10.1097/MPG.0000000000002128
Original Articles: Nutrition
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Objectives: The aim of the study was to characterize the enteral feeding practices in infants after gastrointestinal surgery.

Methods: We performed a retrospective analysis of infants who underwent intestinal surgery at age <6 months who survived to be fed enterally between January 2012 and June 2017. Demographics, surgical characteristics, feeding practices, and growth-related outcomes during hospitalization, discharge, and follow-up (3, 6, and 12 months) were obtained from the electronic medical records. Descriptive statistics compared infants by their initial diagnosis.

Results: We reviewed 111 infants: necrotizing enterocolitis (NEC) = 21, gastroschisis = 28, atresia = 27, spontaneous intestinal perforation (SIP) = 18, and other diagnoses = 17. Most infants (77%) received mother's milk (MM) as the first postoperative feed, but this differed by diagnosis (P = 0.004). Donor milk was used in 11%, most commonly in infants with NEC and SIP. Infants with NEC were least likely to continue MM in the hospital (7%, P = 0.0014) and were more likely to receive elemental formula. Only 44% of infants received MM at discharge. After 1 year, 25% were fed MM. The majority of infants were discharged with feeding tubes (nasogastric: 35%, gastric: 23%). Although all groups had acceptable weights at discharge, infants with NEC (z score: −1.8) and SIP (z score: −1.1) showed growth failure at 3 months (z scores: −3.3, −3.2, respectively, P < 0.0001), but had appropriate gain by 1 year (z scores: −1.1, −1.7, respectively).

Conclusions: Despite most infants receiving MM in the early postoperative period, <50% at discharge and only 33% at 1-year still received MM. Weight gain after discharge in infants with NEC and SIP warrants close monitoring.

*The Johns Hopkins University School of Medicine

Department of Pediatrics

Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, The Johns Hopkins University School of Medicine, Baltimore, MD.

Address correspondence and reprint requests to Darla R. Shores, MD, PhD, Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, The Johns Hopkins University School of Medicine, 600N. Wolfe Street CMSC 2-116, Baltimore, MD 21287 (e-mail: dshores1@jhmi.edu).

Received 10 April, 2018

Accepted 31 July, 2018

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,