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Postoperative pneumatosis intestinalis in infants does not automatically preclude enteral feeding
A Abhyankar1, J J Corkery, A D Lander
1Institute of Child Health, University of Birmingham, Birmingham, England.
Insights
Select neonatal patients with rectal bleeding or pneumatosis intestinalis after surgery can continue reduced enteral feedings without antibiotics. This approach avoids complications in carefully chosen, stable infants.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Surgical outcomes
Background:
- Feed intolerance is common after neonatal abdominal surgery.
- Rectal bleeding or pneumatosis intestinalis may indicate postoperative necrotizing enterocolitis, typically leading to feeding cessation and intravenous support.
- Current management for suspected necrotizing enterocolitis involves stopping enteral feedings, antibiotics, and total parenteral nutrition.
Purpose of the Study:
- To evaluate the safety and efficacy of continuing reduced enteral feedings in select infants with postoperative rectal bleeding or pneumatosis intestinalis.
- To challenge the standard practice of immediate feeding cessation and antibiotic use in these cases.
Main Methods:
- Retrospective review of 3 infants with 12 episodes of rectal bleeding and 11 episodes of pneumatosis intestinalis post-neonatal abdominal surgery.
- In 7 episodes, enteral feedings were reduced but not stopped, and antibiotics were withheld.
- Infants were clinically stable, >3 kg, >37 weeks postconception, with no significant comorbidities or peritonitis.
Main Results:
- Close monitoring of the 3 infants revealed no early or late complications related to the management strategy.
- Reduced enteral feeding without antibiotics was successfully implemented in carefully selected cases.
Conclusions:
- Clinically stable neonatal patients with postoperative pneumatosis intestinalis or rectal bleeding can be safely managed with reduced enteral feedings and no antibiotics.
- This approach may be a viable alternative to standard care in select cases, potentially reducing the need for total parenteral nutrition.
Background:
A degree of feed intolerance after neonatal abdominal surgery is common but in an otherwise well baby enteral feeding usually is continued at the highest tolerated level. However, the presence of rectal bleeding, pneumatosis intestinalis, or portal vein gas seen on plain abdominal x-rays suggest the possibility of postoperative necrotising enterocolitis. When this happens feedings usually are stopped for 7 to 10 days, and intravenous antibiotics and total parental nutrition are commenced.
Methods:
The authors report 12 episodes of rectal bleeding and 11 episodes of pneumatosis intestinalis in 3 infants who previously had undergone neonatal abdominal surgery for intestinal malformations. In 7 of these episodes, feedings were neither stopped nor were antibiotics given. At the time of these 7 episodes, the infants were more than 3 kg in weight, had no significant cardiac or respiratory pathology, were all clinically stable, had no evidence of peritonitis, had no thrombocytopenia, and were greater than 37 weeks postconception.
Results:
The 3 infants were monitored closely. There were no early or late problems observed attributable to this management.
Conclusion:
Carefully selected clinically stable patients that have postoperative pneumatosis intestinalis or exhibit rectal bleeding may be successfully managed by reduced enteral feedings with no antibiotics. J Pediatr Surg 36:1820-1823.
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