Feeding Practices in Simple Gastroschisis: Insights into Practice Variation from a Multidisciplinary Survey

There is limited evidence to guide feeding practices for neonates with simple gastroschisis. Current management centers on clinician judgment and historic practice patterns. This study aims to characterize practice variability and identify opportunities for standardization to improve patient outcomes. This cross-sectional study surveyed neonatal providers on their feeding practices for simple gastroschisis, focusing on the initiation and advancement of enteral nutrition following abdominal closure. The 27-question survey was administered to members of the American Pediatric Surgical Association and the American Academy of Pediatrics Section of Neonatal-Perinatal Medicine, between October 2024 and January 2025. Data were analyzed using descriptive statistics. Of the 467 respondents, the majority were neonatologists 51% and pediatric surgeons 42% working in academic centers, 75% with level III or IV NICUs, 98%). Participants reported near universal use of an enteric drainage tube after abdominal closure (99%). Half reported no gastroschisis feeding protocols at their institution, and instead, across all respondents, rely on evidence of return of bowel function before starting feeds (84%) typically with human milk (86%), by bottle (60%) and initial volumes of 10-20 mL/kg/day. This study demonstrated variable approaches to feeding hospitalized neonates with simple gastroschisis. Evidence-based and standardized guidelines tailored to this population that support the timely and effective initiation and progression of feeds may help improve clinical outcomes.