Association between consensus‐based nutrition pathway and growth faltering in infants with gastroschisis: A retrospective cohort study

• Published in: JPEN. Journal of parenteral and enteral nutrition 2024-11, Vol.48 (8), p.940-948
• Main Authors: Strobel, Katie M., Kramer, Katelin, Rottkamp, Catherine, Uy, Cherry, Fernandez, Erika, Moyer, Laurel, Elashoff, David, Sabnis, Animesh, DeUgarte, Daniel A., Calkins, Kara L.
• Format: Article
• Language: English
• Subjects: California; Cohort Studies; Consensus; Critical Pathways; Female; Gastroschisis; Gestational Age; growth; Growth Disorders - epidemiology; Growth Disorders - etiology; Guideline Adherence - statistics & numerical data; Humans; Infant; Infant Nutritional Physiological Phenomena; Infant, Newborn; Male; Milk, Human; nutrition; Parenteral Nutrition - methods; Retrospective Studies
• ISSN: 0148-6071; 1941-2444; 1941-2444
• DOI: 10.1002/jpen.2692

Background The University of California Fetal Consortium published that 55% of infants with gastroschisis develop growth faltering by hospital discharge. To address this problem, we developed a nutrition pathway emphasizing (1) early provision of parenteral macronutrients, (2) use of human milk, and (3) growth faltering treatment. This study's goals were to assess adherence to and efficacy of this pathway in infants with gastroschisis across six California hospitals. Methods In 2015, the consortium standardized the care for infants with gastroschisis. To decrease growth faltering rates, between 2019 and 2020, nutrition guidelines were proposed, discussed, revised, and initiated. This study's primary outcome was weight or linear growth faltering (z score decline ≥0.8 in weight or length) at hospital discharge. Adherence measures were assessed. Results One hundred twenty‐six infants with gastroschisis were born prepathway; 52 were born postpathway. Median gestational age was similar between cohorts. Adherence to components of the pathway ranged from 58% to 95%. The proportion of infants with weight or linear growth faltering at discharge was lower after pathway initiation (59.4% vs 36.2%, P = 0.0068). Adjusting for gestational age and fetal growth restriction, the pathway was associated with decreased weight or linear growth faltering (odds ratio [OR] 0.35 [0.16–0.75], P = 0.0060) and decreased linear growth faltering (OR 0.24 [0.096–0.56], P = 0.0062) at discharge. Hypertriglyceridemia, cholestasis, and days to full feeds were similar to published cohorts. Conclusion Fewer infants with gastroschisis experienced weight or length growth faltering at hospital discharge following the implementation of a multicenter nutrition pathway.