Comorbidities Delay Initial Feeding in Neonates with Omphalocele

Purpose:            To describe the effect of comorbidities on feeding outcomes in neonates born with omphalocele.

Methods:           Multi-center retrospective study under IRB #5100169 identified 123 neonates born with an omphalocele between 1992 and 2012 with follow-up to December 2013. Comorbidities assessed in this study were chromosomal abnormalities, congenital heart defects without heart failure (CHD), extreme prematurity (defined as birth before 33 weeks gestation), ventilator dependence at birth, neurologic anomalies, and giant omphalocele (defined as defect containing 75% liver). A cardiologist reviewed the CHD diagnoses and determined that the majority were not likely to have heart failure. Primary feeding outcomes were defined as time from birth to first enteral feed, time after initiation of feeds until full enteral feeds were achieved, and days of total parenteral nutrition (TPN) administration. Median days to reach all outcomes were reported for each comorbidity and compared using the Median Test. A p-value <0.05 achieved significance.

Results:             CHD and extreme prematurity significantly delayed feeding initiation. CHD, giant omphalocele, extreme prematurity, and mechanical ventilator dependence at birth increased the time needed to reach full feeds as well as prolonged their period of TPN dependence. No significant variations were found for the chromosomal or neurologic anomaly comorbidities.

Conclusion:       In neonates born with omphalocele, only CHD and extreme prematurity impede successful initiation of feeding. Chromosomal and neurologic anomalies do not appear to affect any feeding outcomes. Once enteral feeds are introduced, CHD, extreme prematurity, mechanical ventilator requirement at birth, and giant omphalocele significantly delay reaching full feeds.