Lactancia materna en pacientes con defectos congénitos de Pared abdominal. Gastrosquisis y onfalocele

Abstract

El recién nacido con defectos de la pared abdominal constituye una de las presentaciones más dramáticas en medicina, y plantea muchas dificultades en neonatología, principalmente el manejo nutricional. Objetivo: Caracterizar la tolerancia de la lactancia materna y las fórmulas de inicio en pacientes con Gastrosquisis y Onfalocele. Método: Se realizó un ensayo clínico controlado prospectivo, en neonatos con el diagnóstico de Gastrosquisis y Onfalocele que iniciaron vía oral con lactancia materna vs formula de inicio, comparando la evolución de ambos grupos. Resultados: Se incluyeron 21 neonatos. 61,9% eran femenino; la edad gestacional y peso al nacer promedio fueron 36,5±1,4 semanas y 2247,9±401,4gr respectivamente. Al 85,7% de los pacientes se les realizó cierre primario del defecto de pared abdominal. La Gastrosquisis fue la más frecuente (76,2%). Hubo diferencias estadísticamente significativas en cuanto al inicio de la alimentación posterior a la cirugía; grupo de lactancia materna (10,2±10,5 días) vs fórmula láctea (20,9±15,3 días), p=0,007. La tolerancia oral definitiva después que iniciaron la primera alimentación fue de 4,4 ±1,4 días en el grupo lactancia materna y de 11±5,5 días con fórmula láctea (p<0,001). La estancia hospitalaria fue menor en el grupo de pacientes que recibieron lactancia materna (24,1±11,2 días) vs fórmula láctea (47,5±22,9 días), p=0,005. La principal complicación fue la sepsis (66,67%). no hubo pacientes fallecidos. Conclusiones: La lactancia materna fue superior a la fórmula láctea en el inicio temprano de tolerancia de la vía oral y la alimentación completa. Los recién nacidos que recibieron lactancia materna se correlacionaron con menor estadía hospitalaria.

The newborn with a defect of the abdominal wall constitutes one of the most dramatic presentations in medicine, and poses many difficulties in neonatology, mainly nutritional management. Objective: To characterize the tolerance of breastfeeding and the starting formula in patients with abdominal wall defects Gastroschisis and Omphalocele. Methods: A prospective controlled clinical trial was carried out in neonates, with the diagnosis of Gastroschisis and Omphalocele that began orally with breastfeeding vs starting formula, comparing the evolution of both groups. Results: 21 Newborns were included. 61.9% were female, the average gestational age and birth weight were 36.5 ± 1.4 weeks and 2247.9 ± 401.4gr respectively. 85.7% of the patients underwent primary closure of the abdominal wall defect. Gastroschisis was the most frequent (76.2%). There were statistically significant differences regarding the start of the first meal after surgery; breastfeeding group (10.2 ± 10.5 days) vs. milk formula (20.9 ± 15.3 days), p = 0.007. The final oral tolerance after starting the first meal was 4.4 ± 1.4 days in the breastfed group and 11 ± 5.5 days milk formula (p the newborn with a defect of the abdominal wall constitutes one of the most dramatic presentations in medicine, and poses many difficulties in neonatology, mainly nutritional management. Objective: To characterize the tolerance of breastfeeding and the starting formula in patients with abdominal wall defects gastroschisis and omphalocele. Methods: A prospective controlled clinical trial was carried out in neonates, with the diagnosis of Gastroschisis and Omphalocele that began orally with breastfeeding vs starting formula, comparing the evolution of both groups. Results: 21 newborns were included. 61.9% were female, the average gestational age and birth weight were 36.5 ± 1.4 weeks and 2247.9 ± 401.4gr respectively. 85.7% of the patients underwent primary closure of the abdominal wall defect. Gastroschisis was the most frequent (76.2%). there were statistically significant differences regarding the start of the first meal after surgery; breastfeeding group (10.2 ± 10.5 days) vs. milk formula (20.9 ± 15.3 days), p = 0.007. the final oral tolerance after starting the first meal was 4.4 ± 1.4 days in the breastfed group and 11 ± 5.5 days milk formula (p <0.001). Hospital stay was shorter in the group of patients who received breastfeeding (24.1 ± 11.2 days) vs. maternal formula (47.5 ± 22.9 days), p = 0.005. the main complication was sepsis (66.67%). there were no deceased patients. Conclusion: Breastfeeding was superior to the milk formula in the early onset of tolerance of the oral route and complete feeding. Newborns who received breastfeeding correlated with a shorter hospital stay.