The Effect of Time-to-Surgery on Enteral Feeding Outcomes in Neonates with Uncomplicated Gastroschisis

Pattarin Lertnuwat

doi:10.64387/tjs.2026.278663

Authors

Pattarin Lertnuwat Division of Pediatric Surgery, Department of Surgery, Lampang Regional Hospital

DOI:

https://doi.org/10.64387/tjs.2026.278663

Keywords:

Gastroschisis, Abdominal wall defects, Time-to-surgery, Abdominal wall closure method

Abstract

Objectives: To evaluate the effect of time-to-surgery on enteral feeding outcomes in neonates with uncomplicated gastroschisis.

Materials and Methods: Retrospective review of NICU admissions for gastroschisis in Lampang Hospital, February 2014 – December 2024. The primary outcomes were the time to initiation of enteral feeding and the time to full enteral feeding (discontinuation of parenteral nutrition).

Results: Twenty-three patients with uncomplicated gastroschisis were analyzed in this study. Ten cases (43.5%) underwent surgery in less than 2 hours, 4 (17.4%) between 2–4 hours, 2 (8.7%) between 4–6 hours, 2 (8.7%) between 6–8 hours, and 5 (21.7%) between 8–10 hours. Primary fascial closure was performed in 5 cases (21.7%) and silo placement with staged closure in 18 cases (78.3%). The mean and median times to surgical intervention were 4.5 and 4 hours, respectively (range, 0.5–10 hours). The median time to start enteral feeding and achieve full enteral feeding was 15 days (IQR, 14.25–20.5) and 23.5 days (IQR, 21.0–28.0), respectively. One patient in the 8-10 hours group, managed with staged closure, died due to ventilator-associated pneumonia and sepsis. There were no statistically significant differences regarding the days to start enteral feeding, days to full enteral feeding, days to extubation, and length of stay. However, a clinical trend toward earlier enteral feeding and a shorter duration of total parenteral nutrition (TPN) was observed when surgery was performed earlier.

Conclusion: Although statistical significance was not reached, this study demonstrated that earlier surgical intervention may affect enteral feeding outcomes, specifically the time to start feeding and the duration of TPN in uncomplicated gastroschisis. Therefore, prenatal diagnosis and prompt in utero maternal transfer to a tertiary pediatric surgical center are advocated.

References

Holland AJ, Walker K, Badawi N. Gastroschisis: an update. Pediatr Surg Int. 26(9):871-8. doi: 10.1007/s00383-010-2679-1.

Langer JC, Longaker MT, Crombleholme TM, et al. Etiology of intestinal damage in gastroschisis. I: Effects of amniotic fluid exposure and bowel constriction in a fetal lamb model. J Pediatr Surg. 24(10):992-7. doi: 10.1016/s0022-3468(89)80200-3.

Saranrittichai S. Gastroschisis: delivery and immediate repair in the operating room. J Med Assoc Thai. 91(5):686-92.

Coughlin JP, Drucker DE, Jewell MR, et al. Delivery room repair of gastroschisis. Surgery. 114(4):822-6.

O'Shea K, Harwood R, O'Donnell S, et al. Does the time to the theater matter in simple gastroschisis? World J Pediatr Surg. 6(4):e000575. doi: 10.1136/wjps-2023-000575.

Klein MD. Congenital defects of the abdominal wall. In: Coran AG, editors. Pediatric Surgery. 7th ed. Philadelphia: Elsevier Saunders; 2012. p. 973-84. ISBN: 978-0323072557.

Skarsgard ED. Management of gastroschisis. Curr Opin Pediatr. 28(3):363-9. doi: 10.1097/MOP.0000000000000336.

Fraga MV, Laje P, Peranteau WH, et al. The influence of gestational age, mode of delivery, and abdominal wall closure method on the surgical outcome of neonates with uncomplicated gastroschisis. Pediatr Surg Int. 34(4):415-9. doi: 10.1007/s00383-018-4233-5.

Singh SJ, Fraser A, Leditschke JF, et al. Gastroschisis: determinants of neonatal outcome. Pediatr Surg Int. 19(4):260-5. doi: 10.1007/s00383-002-0886-0.

Nicholls G, Upadhyaya V, Gornall P, et al. Is specialist centre delivery of gastroschisis beneficial? Arch Dis Child. 69(1 Spec No):71-2. doi: 10.1136/adc.69.1_spec_no.71.

Swift RI, Singh MP, Ziderman DA, et al. A new regime in the management of gastroschisis. J Pediatr Surg. 27(1):61-3. doi: 10.1016/0022-3468(92)90106-h.

Pratheeppanyapat T, Tepmalai K, Singhavejsakul J, et al. The factors associated with successful early enteral feeding in gastroschisis. Pediatr Surg Int. 34(7):743-8. doi: 10.1007/s00383-018-4282-9.

Tawil KA, Gillam GL. Gastroschisis: 13 years' experience at RCH Melbourne. J Paediatr Child Health. 31(6):553-6. doi: 10.1111/j.1440-1754.1995.tb00883.x.

Bucher BT, Mazotas IG, Warner BW, et al. Effect of time to surgical evaluation on the outcomes of infants with gastroschisis. J Pediatr Surg. 47(6):1105-10. doi: 10.1016/j.jpedsurg.2012.03.016.

Quirk JG Jr, Fortney J, Collins HB 2nd, et al. Outcomes of newborns with gastroschisis: the effects of mode of delivery, site of delivery, and interval from birth to surgery. Am J Obstet Gynecol. 174(4):1134-8. doi: 10.1016/s0002-9378(96)70655-5.

Stoodley N, Sharma A, Noblett H, et al. Influence of place of delivery on outcome in babies with gastroschisis. Arch Dis Child. 68(3 Spec No):321-3. doi: 10.1136/adc.68.3_spec_no.321.

Luck SR, Sherman JO, Raffensperger JG, et al. Gastroschisis in 106 consecutive newborn infants. Surgery. 98(4):677-83.

Dore Reyes M, Triana Junco P, Barrena Delfa S, et al. Primary versus secondary closure: ventilatory and nutritional differences in patients with gastrosquisis (in Spanish). Cir Pediatr. 29(2):49-53.

Novotny DA, Klein RL, Boeckman CR. Gastroschisis: an 18-year review. J Pediatr Surg. 28(5):650-2. doi: 10.1016/0022-3468(93)90022-d.

Sangkhathat S, Patrapinyokul S, Chiengkriwate P, et al. Infectious complications in infants with gastroschisis: an 11-year review from a referral hospital in southern Thailand. J Pediatr Surg. 43(3):473-8. doi: 10.1016/j.jpedsurg.2007.10.026.

Alali JS, Tander B, Malleis J, et al. Factors affecting the outcome in patients with gastroschisis: how important is immediate repair? Eur J Pediatr Surg. 21(2):99-102. doi: 10.1055/s-0030-1267977.