Feeding Practices in Simple Gastroschisis: Insights into Practice Variation from a Multidisciplinary Survey.

Abstract

Objective: There is limited evidence to guide feeding practices for neonates with simple gastroschisis. Current management consists of a combination of clinician judgment and historic practice patterns. This study aims to characterize practice variability and identify opportunities for standardization to improve patient outcomes.

Study design: In this cross-sectional study, we surveyed neonatal providers on their feeding practices for simple gastroschisis, focusing on the initiation and advancement of enteral nutrition after abdominal closure. The 27-question survey was administered to members of the American Pediatric Surgical Association and the American Academy of Pediatrics Section of Neonatal-Perinatal Medicine between October 2024 and January 2025. Data were analyzed using descriptive statistics.

Results: Of the 467 respondents, the majority were neonatologists (51%) and pediatric surgeons (42%) working in academic centers (75%) with level III or IV neonatal intensive care units (98%). Participants reported near-universal use of an enteric drainage tube after abdominal closure (99%). One-half reported no gastroschisis feeding protocols at their institution, and instead, across all respondents, rely on evidence of return of bowel function before starting feeds (84%) typically with human milk (86%), by bottle (60%) and initial volumes of 10-20 mL/kg/day.

Conclusions: This study demonstrated variable approaches to feeding hospitalized neonates with simple gastroschisis. Evidence-based and standardized guidelines tailored to this population that support the timely and effective initiation and progression of feeds may help improve clinical outcomes.