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Babies who have gastroschisis typically are born at 34 to 38 weeks’ gestational age and undergo placement of a silo or primary abdominal closure within the first few hours after birth (Fig. 1). In general, affected infants do not have other life-threatening anomalies, and surgical management may be directed at repair of the intestinal herniation and abdominal wall defect. All affected infants have malrotation because the intestine failed to return to the abdominal cavity and become internally fixed. Approximately 10% have an intestinal atresia. Other anomalies are rare, in contrast to the infants who have omphalocele, in whom 50% have chromosomal with or without anatomic anomalies.
The timing and method of delivery for infants who have gastroschisis remain somewhat controversial. One of the potential complications of the condition is the development of thickened bowel or a peel that makes...
Comments
Response to Dr Piecuch
I am in agreement with Dr Piecuch that feeding these infants with breast milk and starting with colostrum is preferable if it is available. It is our standard method of feeding when these children are first started on enteral nutrition. Sometimes circumstance does not allow mothers to provide the milk or they have no desire to do so and in those situations we use prepared formula. Whether the use of breast milk will prevent the development on NEC in an infant with gastroschisis is unclear, however there is evidence to suggest that it is at least beneficial and may help protect the child from this potentially devastating complication. John Waldhausen
Conflict of Interest:
None declared
Human Breast Milk May Reduce NEC Risk After Gastroschisis Repair
Waldhausen, in his comprehensive review of the surgical management of gastroschisis, discusses the feeding problems and increased risk of necrotizing enterocolitis (NEC) seen in these patients. While all those who care for newborns should emphasize the benefits of breast feeding to mothers, I think that it is particularly important to recognize the potential protective effects of human breast milk (HBM) feedings in the post- operative gastroschisis patient. Neonates fed HBM have been found to have a significantly lower risk of NEC compared with infants fed artificial formulas. (1) This protective effect of HBM may be due to specific HBM components, such as platelet-activating factor-acetyl hydrolase or epidermal growth factor, or may be due to reduced colonization of the HBM-fed infant’s gastrointestinal tract with pathogenic bacteria. (2) At least one study has demonstrated a reduction in NEC risk in post-operative gastroschisis patients, with a high incidence of NEC in the artificially fed infants and a statistically significant lower incidence in those infants fed partially or completely with HBM. (3) The neonatologist and pediatric surgeon should make a special effort to encourage mothers of infants with gastroschisis to provide their infants with HBM.
1. Reber KM, Nankervis CA. Necrotizing enterocolitis: preventative strategies. Clin Perinatol 2004; 31:157-67.
2. Dai D, Walker WA. Protective nutrients and bacterial colonization in the immature human gut. Adv Pediatr 1999; 46:353-82.
3. Jayanthi S, Seymour P, Puntis JW, Stringer MD. Necrotizing enterocolitis after gastroschisis repair: a preventable complication? J Pediatr Surg 1998; 33:705-7.
Conflict of Interest:
None declared