Delayed Enteral Feeding in Infants with Giant Omphalocele

Purpose:

The optimal time to establish enteral feeds in infants with omphalocele is unknown.  This study aimed to determine the timing of initiation and success of enteral feeding in infants with omphalocele.

Methods:

A multi-center, retrospective, IRB approved (5100169) study was completed for 123 infants born with omphalocele between 1992 and 2012 with follow-up to December 2013.  Data were compared in infants with giant (defined as defect containing 75% liver) versus non-giant omphalocele to assess variables likely to influence enteral feeding. A single cardiologist reviewed all infants with congenital heart defects and did not identify any lesions likely to contribute to heart failure. Variables were compared using t-tests for continuous and chi-square tests for categorical variables. P-values less than 0.05 achieved significance.

                                                         

Results:

We identified 52/123 (43%) giant omphalocele, 20/52 (38.5%) were males with a mean gestational age of 36.7 +/-3.1 weeks. Median follow-up for the middle 50% of the cohort was 32 months (range of 4.3-86 months). Mean time to full feeds in infants with giant omphalocele was 21 versus 8 days compared to non-giant omphalocele (p = 0.08).  Infants with giant omphalocele required significantly more total parenteral nutrition (TPN) (p = 0.008), had increased rates of ventilation at birth (p<0.001) and increased mortality (p=0.007).

Conclusion:

This large retrospective study suggests that infants with omphalocele establish enteral feeds within the first week of life. Infants with giant omphalocele are slower in reaching full enteral feeds and require significantly more TPN.  Their feeding course may be complicated by a significantly higher rate of ventilation at birth.