Correlation between Duration of Postoperative Parenteral Nutrition and Incidence of Postoperative Complication in Gastroschisis Patients
Akkrapol Mungnirandr MD*, Jiraporn Khorana MD*, Ravit Ruangtrakool MD*
Affiliation : * Division of Pediatric Surgery, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Gastroschisis is the most common neonatal anterior abdominal wall defect. Since all neonatal infants with
gastroschisis require total parenteral nutrition (TPN), the authors retrospectively review was to find correlation between
duration of TPN and postoperative complications including necrotizing enterocolitis (NEC) and poor feeding in gastroschisis
patients. The secondary objective of the present study was to find correlation(s) among length of stay (LOS), gestational age
(GA), birthweight(BW), type of operation and postoperative complications.
Material and Method: Forty-one gastroschisis patients were reviewed during 2001 to 2006. Postoperative complications
were analysed among duration of TPN, LOS, GA,BW,and type of operation. Multiple parameters affecting gastroschisis
patients with NEC were compared with those without NEC.
Results : There were 21 male and 20 female infants. Normal labour was the major route of delivery (31 in 39 infants).
Complications from TPN usage included line infection 5/40, central line requirement 9/40, cutdown requirement 5/40, sepsis
7/40, and TPN leakage 1/40. NEC and poor feeding were 6/40 and 9/40 respectively. In the present study, the Incidence of NEC
in gastroschisis was 15%. NEC and poor feeding were significantly correlated with longer TPN administration (p = 0.0046
& p = 0.0042). Lowest bodyweight of gastroschisis infants occured in the 5.39 + 3.19 days after birth. Gastroschisis patients
with NEC were frequently found with low birthweight and premature (p = 0.007 & 0.028). All gastroschisis infants with NEC
were delivered vaginally. No correlation was shown between time to first oral feeding and development of NEC (p = 0.964).
Conclusion : Longer TPN administration time was found in gastroschisis patients with NEC and poor feeding. Duration of
NPO after operation did not associate with NEC development. NEC was more likely to occur in gastroschisis patients with low
birthweight and prematurity. All of the gastroschisis infants with NEC were born through the vaginal route. Like other
newborn babies, gastroschisis patients lose their bodyweight during the first week of life and gradually gain bodyweight
thereafter.
Keywords : Gastroschisis, Total parenteral nutrition, Necrotizing enterocolitis, Post operative complications
