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Feeding Post-Pyloromyotomy: A Meta-analysis
Katrina J Sullivan1, Emily Chan1, Jennifer Vincent1
1Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; and.
Insights
Ad libitum feeding after pyloromyotomy is recommended for a shorter hospital stay. Structured feeding may be preferred, but early rapid feeds can also reduce length of stay (LOS).
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Nutrition
Background:
- Postoperative emesis is a common complication following pyloromyotomy in infants.
- Optimal postoperative feeding strategies remain undefined, despite their potential influence on outcomes.
Purpose of the Study:
- To systematically review and compare the impact of various postoperative feeding regimens on clinical outcomes in infants undergoing pyloromyotomy.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (CINAHL, Cochrane, Embase, Medline).
- Two independent reviewers assessed study eligibility based on predefined criteria.
- Data extraction focused on study quality, intervention details, and clinical outcomes, including emesis and length of stay.
Main Results:
- Fourteen studies were included in the analysis.
- Ad libitum feeding was associated with a significantly shorter length of stay (LOS) compared to structured feeding.
- While gradual feeding reduced emesis episodes, rapid feeding and late feeding strategies also demonstrated benefits in LOS and reduced emesis, respectively.
Conclusions:
- Ad libitum feeding is recommended post-pyloromyotomy to decrease LOS.
- If structured feeding is implemented, early rapid feeds are suggested to potentially reduce LOS.
- Limitations include the exclusion of non-English studies and a lack of randomized controlled trials.
Context:
Postoperative emesis is common after pyloromyotomy. Although postoperative feeding is likely to be an influencing factor, there is no consensus on optimal feeding.
Objective:
To compare the effect of feeding regimens on clinical outcomes of infants after pyloromyotomy.
Data Sources:
Cumulative Index to Nursing and Allied Health Literature, The Cochrane Central Register of Controlled Trials, Embase, and Medline.
Study Selection:
Two reviewers independently assessed studies for inclusion based on a priori inclusion criteria.
Data Extraction:
Data were extracted on methodological quality, general study and intervention characteristics, and clinical outcomes.
Results:
Fourteen studies were included. Ad libitum feeding was associated with significantly shorter length of stay (LOS) when compared with structured feeding (mean difference [MD] -4.66; 95% confidence interval [CI], -8.38 to -0.95; P = .01). Although gradual feeding significantly decreased emesis episodes (MD -1.70; 95% CI, -2.17 to -1.23; P < .00001), rapid feeding led to significantly shorter LOS (MD 22.05; 95% CI, 2.18 to 41.93; P = .03). Late feeding resulted in a significant decrease in number of patients with emesis (odds ratio 3.13; 95% CI, 2.26 to 4.35; P < .00001).
Limitations:
Exclusion of non-English studies, lack of randomized controlled trials, insufficient number of studies to perform publication bias or subgroup analysis for potential predictors of emesis.
Conclusions:
Ad libitum feeding is recommended for patients after pyloromyotomy as it leads to decreased LOS. If physicians still prefer structured feeding, early rapid feeds are recommended as they should lead to a reduced LOS.
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