Feasibility of neonatal intravenous nutrition for the management of gastroschisis in sub-Saharan Africa.

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.