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Impact of Breast Milk, Respiratory Insufficiency, and Gastroesophageal Reflux Disease on Enteral Feeding in Infants With Omphalocele

Haug, Shelly*; St. Peter, Shawn; Ramlogan, Sandhya; Goff, Donna§; Thorpe, Donna||; Hopper, Andrew*; Baerg, Joanne

Journal of Pediatric Gastroenterology and Nutrition: June 2019 - Volume 68 - Issue 6 - p e94–e98
doi: 10.1097/MPG.0000000000001463
Original Articles: Gastroenterology
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Objectives: The aim of this study was to document the process of achieving full enteral feeding in infants with omphalocele and to identify factors that affect feeding success.

Methods: After institutional review board approval (study no. 5100169), 123 infants with omphalocele, born between 1993 and 2011 were reviewed. Mortalities were excluded. All survivors had complete follow-up. Variables suspected to impact enteral feeding in infants with non-giant versus giant omphalocele were compared. Independent t test, Mann-Whitney, and χ2 test were used. Regression evaluated for variable independence.

Results: Of 123 infants with omphalocele, 97 (79%) survived, 62/97 (64%) had non-giant, and 35/97 (36%) giant omphalocele. For survivors, the mean gestational age was 37 ± 4 weeks with median follow-up of 4.4 years (range: 1.4–7.4 years). The median time to full feeds was 4 days (range: 0–85 days) for non-giant versus 8 days (range: 1–96 days) for giant, a significant difference (P < 0.01). Breast milk significantly decreased time to full feeds independent of omphalocele size. Giant omphalocele infants had a significantly higher incidence of respiratory insufficiency at birth (P < 0.01) and sac rupture (P = 0.02), but fewer chromosomal anomalies (P = 0.04). Respiratory insufficiency at birth (P < 0.01) and gastroesophageal reflux disease (P < 0.01) independently delayed feeding in omphalocele infants.

Conclusions: Infants with non-giant omphalocele can achieve full enteral feeds within the first week of life, but giant omphalocele infants require significantly more time. Breast milk independently promotes feeding success whereas gastroesophageal reflux disease and respiratory insufficiency at birth independently delay feeding in infants with omphalocele.

*Division of Neonatology, Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA

Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO

Division of Cardiology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO

§Division of Cardiology, Department of Pediatrics, Loma Linda University Children's Hospital

||School of Allied Health, Loma Linda University

Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, CA.

Address correspondence and reprint requests to Shelly Haug, MD, Division of Neonatology, Loma Linda University Children's Hospital, 11175 Campus St, Coleman Pavilion Suite 11121, Loma Linda, CA 92354 (e-mail: sgiven@llu.edu).

Received 29 October, 2015

Accepted 23 August, 2016

The authors report no conflicts of interest.

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