O2213: Nutritional Challenges and Supplementation Need in Infants with Cloacal Exstrophy

Background: Cloacal exstrophy (CE) is a rare congenital anomaly that presents severe multisystem anomalies significantly affecting nutrition and growth due to short gut physiology. This study aims to identify nutritional deficits and the need for supplementation in CE infants after the first stage of surgical repair.

Methods: We retrospectively reviewed CE infants treated at a single institution from 2013 to 2021. Data collected included gestational age, birth weight, congenital anomalies, surgical details, feeding routes, and weight gain. Nutritional status was assessed using Z-scores to identify malnutrition (Z-score < -2).

Results: Eight CE patients (6 male, 2 female) were identified. 50% had associated congenital cardiac anomalies, 38% had congenital bowel malrotation, and 50% had documented congenital short gut syndrome. Median age at first repair was 3 days, with a median weight of 2.2 kg (weight-for-age Z-score = -1.95). Malnutrition persisted in most patients past one year [Figure 1]. Enteral nutrition began at a median of 7 days post-first repair [Table 1], with 43% requiring enteral tube feeding for adequate growth. Patients underwent a median of three additional surgeries before the second stage. The median initial hospitalization was 63 days (range: 20-407). Five patients proceeded to the second repair at a median age of 23.4 months, with 60% requiring gastrostomy feeds.

Conclusion: CE infants experience prolonged hospitalizations and significant nutritional challenges. Early identification of these deficits and collaborating with nutrition and rehabilitation teams is essential to optimize outcomes.