The Impact of Breast Milk, Respiratory Insufficiency and GERD on Enteral Feeding in Infants with Omphalocele.

OBJECTIVES: The aim of this study was to document the process of achieving full enteral feeding in infants with omphalocele and to identify factors that affect feeding success.

METHODS: After Institutional Review Board approval (5100169), 123 infants with omphalocele, born between 1993 and 2011 were reviewed. Mortalities were excluded. All survivors had complete follow-up. Variables suspected to impact enteral feeding in infants with non-giant versus giant omphalocele were compared. Independent t-test, Mann-Whitney and chi-square test were utilized. Regression evaluated for variable independence.

RESULTS: Of 123 infants with omphalocele, 97 (79%) survived, 62/97 (64%) had non-giant and 35/97 (36%) giant omphalocele. For survivors, the mean gestational age was 37+/-4 weeks with median follow-up of 4.4 years (range: 1.4 to 7.4 years).The median time to full feeds was 4 days (range: 0 to 85 days) for non-giant versus 8 days (range: 1 to 96 days) for giant, a significant difference (p < 0.01). Breast milk significantly decreased time to full feeds independent of omphalocele size. Giant omphalocele infants had a significantly higher incidence of respiratory insufficiency at birth (p < 0.01) and sac rupture (p= 0.02), but fewer chromosomal anomalies (p = 0.04). Respiratory insufficiency at birth (p < 0.01) and gastroesophageal reflux disease (GERD) (p < 0.01) independently delayed feeding in omphalocele infants.

CONCLUSIONS: Infants with non-giant omphalocele can achieve full enteral feeds within the first week of life, but giant omphalocele infants require significantly more time. Breast milk independently promotes feeding success while GERD and respiratory insufficiency at birth independently delay feeding in infants with omphalocele.