Gastroschisis and Breastmilk
by Anne Eglash MD, IBCLC, FABM
Gastroschisis is a condition that occurs during fetal development, causing the intestines to be exposed outside of the abdominal wall at birth.
According to authors of this week's article, the incidence of gastroschisis has been increasing, particularly for infants born to teenage mothers, and now occurs at a rate of 4.42 per 10,000 births. Because the intestines are directly exposed to amniotic fluid during fetal development, the intestines may experience a range of injuries including lack of proper development, twisting, or death to portions of the intestine.
Infants born with gastroschisis undergo surgery and prolonged hospital stays due to feeding difficulties.
Because breastmilk has many bioactive factors that help mature the intestines and improve nutrient absorption while also reducing the risk of infection, the authors of this study explored whether the provision of breastmilk during the recovery process was associated with faster recovery and shorter hospital stays.
This study reviewed the charts of 49 infants admitted to Rush University Medical Center's NICU from 2015 to 2016 with a diagnosis of gastroschisis. None of the infants received donor human milk, only mother's own milk (MOM).
They found that all 7 of the 49 infants who received 100% MOM were discharge by day 25 after feeding initiation, whereas 60% of infants who received less than 100% MOM were still hospitalized at day 25.
Yes or No?
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To determine if mother’s own milk (MOM) dose after gastroschisis repair is associated with time from feeding initiation to discharge. Secondary outcomes included parenteral nutrition (PN) duration and length of stay (LOS).
Retrospective study of 44 infants with gastroschisis examined demographics, gastroschisis type, PN days, timing of nutrition milestones, feeding composition, and LOS.
MOM dose was significantly associated with shorter time to discharge from feeding initiation (adjusted hazard ratio [HR] for discharge per 10% increase in MOM dose, 1.111; 95% CI, 1.011–1.220, p = 0.029). MOM dose was also significantly associated with shorter LOS (adjusted HR for discharge per 10% increase in MOM dose, 1.130; 95% CI, 1.028–1.242, p = 0.011).
MOM dose was significantly associated with a decrease in time to discharge from feeding initiation and LOS in a dose-dependent manner. Mothers of gastroschisis patients should receive education and proactive lactation support to optimize MOM volume for feedings.
There has been little documentation on the importance of breastmilk feedings for infants with gastroschisis, so this article adds to a few other studies that also found improved healing and shorter lengths of hospital stay for infants with gastroschisis who receive mother's own milk. This all makes sense of course because of what we know about the effect of breastmilk components on the maturation process of the gut, establishment of an optimal intestinal microbiome, and reduction in infection risk.
The authors point out that we don't have evidence on the role of pasteurized donor human milk for infants with gastroschisis, but given that infants with 100% breastmilk feeding did so well, it would make sense that donor milk should be offered to infants with gastroschisis who have an insufficient amount of MOM. Because some NICUs have limitations on the use of donor human milk based on weight and gestational age, infants with gastroschisis should be considered an exemption to those rules.
The authors also remind us that mothers of ill or premature infants require special care and attention to help them establish sufficient milk supplies. Mother’s milk supply could be incorporated as a vital sign for the healthcare team during rounds.