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Articles: John H. T. Waldhausen Surgical Management of Gastroschisis Neoreviews 2005; 6: e500-e507 [Full text] [PDF]

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Human Breast Milk May Reduce NEC Risk After Gastroschisis Repair

Steve Piecuch, MD, MPH   (4 December 2005)

Response to Dr Piecuch

John H.T. Waldhausen   (7 March 2006)

Human Breast Milk May Reduce NEC Risk After Gastroschisis Repair 4 December 2005
Steve Piecuch, MD, MPH, Clinical Associate Professor of Pediatrics SUNY-Downstate Medical Center, Brooklyn Send letter to journal: Re: Human Breast Milk May Reduce NEC Risk After Gastroschisis Repair stevepiecuch{at}aol.com Steve Piecuch, MD, MPH	Waldhausen, in his comprehensive review of the surgical management of gastroschisis, discusses the feeding problems and increased risk of necrotizing enterocolitis (NEC) seen in these patients. While all those who care for newborns should emphasize the benefits of breast feeding to mothers, I think that it is particularly important to recognize the potential protective effects of human breast milk (HBM) feedings in the post- operative gastroschisis patient. Neonates fed HBM have been found to have a significantly lower risk of NEC compared with infants fed artificial formulas. (1) This protective effect of HBM may be due to specific HBM components, such as platelet-activating factor-acetyl hydrolase or epidermal growth factor, or may be due to reduced colonization of the HBM-fed infant’s gastrointestinal tract with pathogenic bacteria. (2) At least one study has demonstrated a reduction in NEC risk in post-operative gastroschisis patients, with a high incidence of NEC in the artificially fed infants and a statistically significant lower incidence in those infants fed partially or completely with HBM. (3) The neonatologist and pediatric surgeon should make a special effort to encourage mothers of infants with gastroschisis to provide their infants with HBM. 1. Reber KM, Nankervis CA. Necrotizing enterocolitis: preventative strategies. Clin Perinatol 2004; 31:157-67. 2. Dai D, Walker WA. Protective nutrients and bacterial colonization in the immature human gut. Adv Pediatr 1999; 46:353-82. 3. Jayanthi S, Seymour P, Puntis JW, Stringer MD. Necrotizing enterocolitis after gastroschisis repair: a preventable complication? J Pediatr Surg 1998; 33:705-7. Conflict of Interest: None declared
Response to Dr Piecuch 7 March 2006
John H.T. Waldhausen, Surgeon Seattle Children's Hospital Send letter to journal: Re: Response to Dr Piecuch Waldhausen{at}seattlechildrens.org John H.T. Waldhausen	I am in agreement with Dr Piecuch that feeding these infants with breast milk and starting with colostrum is preferable if it is available. It is our standard method of feeding when these children are first started on enteral nutrition. Sometimes circumstance does not allow mothers to provide the milk or they have no desire to do so and in those situations we use prepared formula. Whether the use of breast milk will prevent the development on NEC in an infant with gastroschisis is unclear, however there is evidence to suggest that it is at least beneficial and may help protect the child from this potentially devastating complication. John Waldhausen Conflict of Interest: None declared