World journal of pediatric surgery · 2026
Feasibility of neonatal intravenous nutrition for the management of gastroschisis in sub-Saharan Africa.
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Wright Naomi, Alberti Piero, Olaiya Aarinola, Abantanga Francis, Abdul-Mumin Alhassan, Amoah Michael, Appeadu-Mensah William, Bokhary Zaitun, Bvulani Bruce, Mulewa Mulenga, Nandi Bip, Nimako Boateng, Sama Philipo Godfrey, Tabiri Stephen, Yifieyeh Abiboye, Arnold Kate, Greenough Anne, Sevdalis Nick, Leather Andrew, Naik Sandhia, Ade-Ajayi Niyi
Аннотация
INTRODUCTION: Parenteral nutrition (PN) is a life-saving intervention for neonates with gastroschisis. As most low and middle-income countries lack access to comprehensive neonatal PN, we evaluated the feasibility and safety of a pragmatic intravenous nutrition strategy for neonates with gastroschisis in sub-Saharan Africa.
METHODS: Local protocols for partial parenteral nutritional support and early enteral feeding were developed across the seven pediatric surgery centers participating in the Gastroschisis Interventional Study (n=192). Protocols aimed to provide up to 100 kcal/kg/day using 10% dextrose as maintenance fluid, with amino acid preparations and lipid emulsions added when locally available. Trophic breastmilk was commenced on admission, with enteral feeds advanced from the day following defect closure.
RESULTS: In the postintervention phase (n=127), all centers administered 10% dextrose as maintenance fluid. Six centers provided parenteral amino acid, and two centers additionally provided parenteral lipid. The proportion of neonates receiving parenteral nutritional support with 10% dextrose and amino acids increased from 18.5% to 66.1% between the pre- and postintervention phases. The median duration of parenteral nutritional support among survivors was 14 days (interquartile range (IQR): 9-22 days). Intravenous nutritional support was mainly administered by peripheral venous access, with no major clinical complications observed.
CONCLUSIONS: Partial neonatal intravenous nutritional support using locally available products was feasible and safe across study centers. This approach represents a pragmatic interim strategy in settings where neonatal PN is unavailable. Expanding access to neonatal PN remains essential to achieving Sustainable Development Goal 3.2 to end preventable neonatal deaths by 2030.
METHODS: Local protocols for partial parenteral nutritional support and early enteral feeding were developed across the seven pediatric surgery centers participating in the Gastroschisis Interventional Study (n=192). Protocols aimed to provide up to 100 kcal/kg/day using 10% dextrose as maintenance fluid, with amino acid preparations and lipid emulsions added when locally available. Trophic breastmilk was commenced on admission, with enteral feeds advanced from the day following defect closure.
RESULTS: In the postintervention phase (n=127), all centers administered 10% dextrose as maintenance fluid. Six centers provided parenteral amino acid, and two centers additionally provided parenteral lipid. The proportion of neonates receiving parenteral nutritional support with 10% dextrose and amino acids increased from 18.5% to 66.1% between the pre- and postintervention phases. The median duration of parenteral nutritional support among survivors was 14 days (interquartile range (IQR): 9-22 days). Intravenous nutritional support was mainly administered by peripheral venous access, with no major clinical complications observed.
CONCLUSIONS: Partial neonatal intravenous nutritional support using locally available products was feasible and safe across study centers. This approach represents a pragmatic interim strategy in settings where neonatal PN is unavailable. Expanding access to neonatal PN remains essential to achieving Sustainable Development Goal 3.2 to end preventable neonatal deaths by 2030.