Does A Multidisciplinary Nutrition Team Improve the Outcomes of Infants With Simple or Complex Gastroschisis?

Abstract

Background: Gastroschisis (GS) impairs intestinal function causing feeding delays, parenteral nutrition (PN) dependence and increased hospital stay (LOS). Due to these difficulties, and literature supporting a multidisciplinary nutrition team (MNT) approach, we instituted a MNT in the NICU for patients with GS, whom we categorized as simple (S-GS) or complex (C-GS) at birth. Objective: To determine whether a multidisciplinary nutrition team (MNT) improves outcome for simple and complex GS patients. Design/Methods: Outcomes were collected for pre-MNT (2005- 2006) and MNT (2007-2009) periods. C-GS was defined as intestinal complications (atresia, perforation, necrosis, volvulus) or delayed closure (>24h); S-GS defined as no complications and primary closure (<24h). Data was analyzed using Mann-Whitney U tests for continuous variables and tests for proportions where appropriate. Results: C-GS infants showed higher medical complexity than S-GS, in the pre-MNT period, with significantly increased LOS, PN days, and time to full feeds (p<0.05). C-GS infants also showed higher complexity than S-GS during the MNT period, with increased LOS (p<0.05). S-GS infants had significantly increased LOS, days to FF, and PN days during MNT period vs pre-MNT (p<0.05). C-GS infants showed a trend to reduced LOS and time to FF during MNT period. There were similar PN days in the two periods and 2 MNT patients went home on PN. The combined effect of PN and time to FF (MNT period) was reflected in a reduced LOS (11%). Both C-GS cohorts had 1 death; the pre-MNT death was at day 172 and the MNT death was 24h after first surgery and not influenced by MNT. Conclusions: Implementation of a MNT appears to improve outcomes in C-GS, but the same conservative approach was not beneficial for S-GS. Categorization at birth helps predict outcomes (favorable/unfavorable) and appears to be a useful tool in determining the appropriate management for S-GC and C-GS. (Table presented).