1075 Nutritional Outcome of Surgical Neonates After Hospital Discharge

Background/Aims: Neonates who have undergone major gastrointestinal (GI) surgery are complex. They often require prolonged artificial nutritional support and hospital stay. Little is known about the nutritional and growth outcomes of surgical neonates (SNs) post-hospital discharge. This study evaluates the prevalence of “failure to thrive” (FTT) in SNs after hospital discharge. Methods: A retrospective analysis was done at Chelsea and Westminster Hospital, a tertiary referral centre for neonatal surgery. Babies who had major GI surgery over an 18-month period (1Jan2006-31Jul2007) were identified from unit's database. Further data were collated from medical case notes, dietetic records, parental satisfaction survey and physician feedback. FTT was defined as weight decreasing over 2 centile lines using unit's standardized growth centile chart. Results: Sixty-five of 80 eligible infants were analysed. Key surgical diagnosis included necrotizing enterocolitis, duodenal stenosis, tracheoesophageal fistula, Hirschsprung's disease and exomphalous. Nineteen SNs(29%) developed FTT, 12/19 as inpatients (4 with further growth impairment postdischarge) and 7/19 after discharge/transfer to local hospital. Twenty SNs(30.8%) were referred for dietetic follow-up after discharge for associated comorbidity e.g. FTT, gastroesophageal reflux, and milk intolerance and in 22/65(33.8%) they required milk change post-discharge e.g. to a hypoallergenic or hypercalorific formula. Post-discharge FTT was common if babies only had surgical without coexisting neonatal follow-up. Conclusion: SNs are shown to be at high risk of FTT even after discharge from hospital, and they require significant dietetic input. We recommend increased awareness of the potential comorbidities and ongoing provision of dedicated multidisciplinary nutritional and neurodevelopmental support for early identification and intervention.