NECROTIZING ENTEROCOLITIS AFTER GASTROSCHISIS REPAIR - A PREVENTABLE COMPLICATION

Background: Necrotizing enterocolitis (NEC) has been documented in up to 20% of infants after repair of gastroschisis and is responsible for significant morbidity. NEC is reported to occur up to 10 times more i n preterm infants receiving standard formula compared with those who h ave been fed exclusively with breast milk. Does breast milk confer a s imilar protection against NEC in infants who have undergone surgery fo r gastroschisis? Methods: All newborns with gastroschisis delivered be tween 1990 and 1996 and treated in a single neonatal unit were analyze d retrospectively. Clinical data, details of feeding regimens, and epi sodes of definite NEC were recorded. Results: Of 60 infants with gastr oschisis, 6 (10%) died but none had evidence of NEC. Of the remaining 54 infants, clinical and radiological signs of NEC developed in 8 (15% ). All recovered with medical treatment including the three patients w ith recurrent episodes. NEC developed in none of the 12 babies exclusi vely fed with expressed breast milk (EBM) in contrast to 1 (5%) of the 19 who received both EBM and formula, and 7 (30%) of the 23 who were fed solely on formula. There was no significant difference in gestatio n, incidence of primary versus silo closure, or incidence of intestina l atresia/stenosis in those with NEC (n = 8) compared with those witho ut (n = 46), but birth weight in the NEC group was lower. NEC was less likely to develop in infants who received EBM than those who were exc lusively formula fed (P < .02). Conclusion: After gastroschisis repair , feeding with maternal expressed breast milk may help to protect the infant from developing NEC. Copyright (C) 1998 by W.B. Saunders Compan y.