Introduction Neonates with surgical gastrointestinal conditions on prolonged parenteral nutrition (PN) are at higher risk of blood stream infections caused by enteric bacteria, which is thought to be due to bacterial translocation. This may lead to poor feed tolerance and malnutrition. Our unit commences oral gut decontamination (OGD) for selective neonates at high risk of bacterial translocation. To our knowledge our unit is unique in the use of OGD to minimise risk of sepsis and poor growth. This study aimed to describe unit practice and review outcomes.

Aims

1. To review the number of episodes of sepsis before and after OGD.

2. To review weights and feed volumes before and after treatment.

Subjects and Methods Retrospective data was collected from single tertiary surgical neonatal unit. Patients who had received OGD over a 2-year period were identified using BadgerNet. Patient records, drug charts and electronic results system were reviewed. After testing for normality, z-scores for weight and feed volumes before and after treatment were compared using paired t-test and Wilcoxon matched pairs test respectively. Sepsis rates before and after treatment were analysed using a two-tailed chi-squared test. P-values of <0.05 were considered significant.

Results Over the 2 year period 13 patients received OGD. (Table 1).

All patients had a surgical diagnosis. One patient died, this was not due to sepsis and they were not on OGD at the time of death.

Indications for starting OGD included previous sepsis episodes, inability to increase enteral feeds due to high stoma output, and poor weight gain.

The mean PN volume was lower following OGD (70mls/kg/day vs. 102mls; p=0.07). Prior to treatment 23% of patients were exclusively on maternal breast milk. Mean enteral feed volume increased after OGD (44mls/kg/day vs. 56mls/kg/day p=0.57). There was marginal increase in weight z-scores after OGD (-1.56 vs. -1.51, p=0.83).

Episodes of sepsis are shown in table 3. Before treatment there were 16 episodes of sepsis; 25% of episodes were gram-negative organisms, 50% gram-positive and 25% mixed. After treatment there were 14 episodes of sepsis of which 14.2% were gram-negative, 64.3% gram-positive and 21.4% mixed.

Summary Use of OGD in neonates has very limited evidence base and is mainly used in surgical babies. The protocol on our unit is extrapolated from adult studies.

In our study we saw an increase in weight, and enteral feed volumes after initiation of OGD for most babies, although neither change reached statistical significance. We also saw a decrease in the proportion of gram-negative sepsis after initiation of OGD. This is due to the antibiotics used mainly targeting gram-negative organisms.

This study adds to the limited literature regarding use of OGD in neonates. Findings of this study were limited by small sample size and heterogenous population.

Conclusion OGD is an infrequently used treatment which may have a role in reducing sepsis secondary to bacterial translocation in this unique population. Further multicentre trials are needed to evaluate the impact of this practice.