Impact of Nutrition Support Team on Postoperative Nutritional Status and Outcome of Patients with Congenital Gastrointestinal Anomalies

BACKGROUND The aim of this study was to evaluate postoperative nutritional status in patients who underwent operations due to congenital gastrointestinal anomalies in surgical neonatal intensive care units (NICUs) and to investigate the role of nutrition support teams (NSTs) on the outcome. METHODS A retrospective clinical study was carried out at two NICUs in Dr. Sheikh Pediatric Hospital, Mashhad, Iran. One of the NICUs was supported by NST and the other was not. A total of 120 patients were included through a non-random simple sampling. Different variables such as age, sex, prematurity, type of anomaly, birth weight, use of vasoactive drugs, weight gain in NICU, length of NICU stay, postoperative enteral nutrition initiation, duration of mechanical ventilation, mortality rate, maximum of blood sugar, the amount of calorie delivered to the calorie requirement ratio, and distribution of energy from enteral or parenteral roots were compared between the patients of two NICUs. RESULTS Median weight gain and the amount of calorie delivered during NICU stay in subjects of NSTsupported NICU was significantly more than other NICU. There was no significant difference in the length of NICU stay, enteral nutrition initiation after the operation, ventilation days, and percent of mortality between the two groups. The percentage of enteral feeding was also increased by about 2.8%, which was not significant. CONCLUSION NST could increase post-operative weight gain and calorie delivery in patients as well as providing an increase in enteral feeding rather than parenteral.

Growth from Birth to 30 months for Infants Born with Congenital Gastrointestinal Anomalies and Disorders

Objective This study aimed to investigate growth among neonates with gastrointestinal disorders. Study Design Inclusion criteria included neonates with gastroschisis, omphalocele, intestinal atresia, tracheoesophageal fistula, Hirschsprung's disease, malabsorption disorders, congenital diaphragmatic hernia, and imperforate anus born between 2010 and 2018. Anthropometrics were collected for the first 30 months, and a subgroup analysis was performed for gastroschisis infants. Results In 61 subjects, 13% developed severe growth failure within the first month. One-, four-, and nine-month weight and length z-scores were less than birth weight in all infants (p < 0.05). In infants with gastroschisis, a similar pattern was observed for weight z-scores only (p < 0.05). From birth to 15 months, head circumference z-score increased over time in all infants (p = 0.001), while in gastroschisis infants, weight, length, and head circumference z-scores increased over time (p < 0.05). Conclusion In a cohort of infants with gastrointestinal disorders, growth failure was followed by catch-up growth.

Radiologic imaging of congenital gastrointestinal anomalies in infants

Background Congenital gastrointestinal anomalies may manifestsigns or symptoms in the first few days of life, most commonly inthe fonn of obstructions. Radiologic imaging plays an importantrole in diagnosis confirmation and surgical correction plans. Mostcases may be diagnosed by plain radiographs alone, but cr scansand MRI may be needed to make accurate diagnoses, especiallyin difficult cases.Objective To report radiologic imaging findings in infants Mthcongenital gastrointestinal anomalies.Methods For this retrospective, cross􀁊sectional study we tooksecondary data from medical records of infants 'With congenitalgastrointestinal anomalies in Dr. Kariadi Hospital, Semarang,Indonesia from January 2010 - June 2011. Diagnosis of congenitalanomalies was confirmed by clinical manifestation and radiologicimaging. Radiologic findings were reviewed by a single radiologiston duty at that time. Data is presented in the form of frequencydistribution.Results Subjects consisted of 50 males and 23 females. The mostcormnon complaints were vorrritingin 14 subjects (19%), alxlominaldistension in 31 subjects (43%), and fecal passage dysfunction in28 subjects (38%). Radiologic imaging of subjects with congenitalgastrointestinal anomalies revealed the folloMng conditions: analatresia in 28 subjects (38%), congenital megacolon in 21 subjects(29%), esophageal atresia in 14 subjects (19%), duodenal atresia in9 subjects (12%), and pyloric atresia in 1 subject (2%).Conclusion Using radiologic imaging of infants with congenitalgastrointestinal anomalies, the most to least common conditionsfound were anal atresia, congenital megacolon, esophagealatresia, duodenal atresia, and pyloric atresia. [Paediatr Indones.2012;52:341-5].

Use of Special Education Services Among Children With and Without Congenital Gastrointestinal Anomalies

Our objective was to evaluate the relationship between congenital gastrointestinal anomalies requiring neonatal surgery and neurodevelopmental outcome. Among the children born in metropolitan Atlanta during 1982–2001 who survived to age 1 year (N = 762,824), we identified children with congenital gastrointestinal anomalies via linkage with the Metropolitan Atlanta Congenital Defects Program and children who received special education services via linkage with the Special Education Database of Metropolitan Atlanta. Several modest increases in special education service use were observed among children with isolated congenital gastrointestinal anomalies; no association was statistically significant. Among children with Hirschsprung disease, gastroschisis, esophageal atresia, intestinal malrotation, bowel atresia, or imperforate anus who had multiple anomalies, we observed statistically significant increases in special education service use.

Associated congenital anomalies: Vestibular fistula, duodenal atresia and obstructive refluxing megaureter

Congenital gastrointestinal anomalies include spectrum of malformations, simple ones as well as complex, which are associated with anomalies of other organs and systems of organs. Most infants (50-60%) with imperforate anus also have genitourinary, cardiovascular, gastrointestinal and vertebral anomalies. This case report is of a female newborn with prenatally diagnosed duodenal atresia and right hydronephrosis. Clinical investigation revealed an imperforate anus with vestibular fistula. A plain abdominal x-ray showed a "double-bubble? sign, characteristic for duodenal atresia. Intraluminal membrane was excised and sigmoid colostomy was performed in general anesthesia on the first day of life. Ultrasound and intravenous pyelography confirmed a hydronephrotic right kidney and obstructive megaureter after Pena. In the fifth month of life, the ureter was tapered and reimplanted. Six months later, posterior sagittal anorectoplasty was performed. In the sewentheenth month of life the colostomy was closed. This child attained normal growth and development, normal bowel control, fecal continence without soiling, obstipation and urinary infections.