Gastroschisis Outcomes: Presence of Histologic Chorioamnionitis and the Impact on Time to Full Enteral Feeds and Length of Hospital Stay

Chukwudi O Ejiofor; Steven Ford; Jose R Duncan; Drew Rideout; Ambuj Kumar; Keyur Donda; Jaime Flores-Torres

doi:10.1055/s-0043-1761298

Gastroschisis Outcomes: Presence of Histologic Chorioamnionitis and the Impact on Time to Full Enteral Feeds and Length of Hospital Stay

Am J Perinatol. 2024 May;41(S 01):e1220-e1227. doi: 10.1055/s-0043-1761298. Epub 2023 Jan 29.

Authors

Chukwudi O Ejiofor¹, Steven Ford², Jose R Duncan³, Drew Rideout⁴, Ambuj Kumar⁵, Keyur Donda², Jaime Flores-Torres²

Affiliations

¹ Department of Pediatrics (Neonatal-Perinatal Medicine), Franciscan Missionaries of Our Lady Health System, Lafayette, Louisiana.
² Division of Neonatology, Department of Pediatrics, University of South Florida College of Medicine, Tampa, Florida.
³ Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa, Florida.
⁴ Division of Pediatric Surgery, Department of Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida.
⁵ Department of Internal Medicine, University of South Florida College of Medicine, Tampa, Florida.

PMID: 36709758
DOI: 10.1055/s-0043-1761298

Abstract

Objective: Despite improvements in our ability for early diagnosis and providing supportive care for infants with gastroschisis, it continues to be associated with long length of stay and morbidity. Intestinal dysfunction secondary to chronic inflammatory insult to exposed bowel is well known; however, little research has been done on the impact of acute inflammation in the perinatal period on intestinal function. This study's aim was to investigate the impact of acute chorioamnionitis on the time to achieve full enteral feeds and length of hospital stay.

Study design: Retrospective chart review of 60 mothers and their infants born with gastroschisis at a Level IV NICU from November 2011 to June 2020 was performed. Infants were divided into two groups based on the presence of histologic chorioamnionitis, and outcomes were compared. The primary outcome was delayed full enteral feeds (full enteral feeds after 28 days of life). The secondary outcomes were differences in their time to achieve full enteral feeds and time to hospital discharge, and prolonged length of hospital stay (discharge after 30 days of life). Univariate and multivariate logistic regression analyses were performed to assess the association between the dependent and the predictor variables.

Result: Of the 60 infants enrolled, 23 (38%) had evidence of histologic chorioamnionitis. The median gestational age was 37 weeks. Fifty-four (90%) infants achieved full enteral feeds, with a median time of 24 days. Median length of hospital stay was 31 days. The presence of histologic chorioamnionitis was not associated with delayed full enteral feeds (odds ratio [OR] = 0.79; 95% confidence interval [CI] = 0.14-4.23; p = 0.80) or prolonged length of hospital stay (OR = 0.45; 95% CI = 0.1-0.23; p = 0.32) in the adjusted analysis.

Conclusion: Acute placental inflammation during the perinatal period does not impact the infant's time to achieve full feeds or prolong their hospital stay. Larger studies are needed to confirm these findings.

Key points: · Chronic inflammatory injury to exposed bowel in utero is well known in fetuses with gastroschisis.. · Acute inflammatory injury during perinatal period may impact enteral feeding outcomes.. · No impact of acute placental inflammation on time to full enteral feeds..

MeSH terms

Adult
Chorioamnionitis*
Enteral Nutrition*
Female
Gastroschisis* / therapy
Gestational Age
Humans
Infant, Newborn
Intensive Care Units, Neonatal
Length of Stay* / statistics & numerical data
Logistic Models
Male
Pregnancy
Retrospective Studies
Time Factors