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Nutritional Advancement in the Hospitalized Child After NPO: A Retrospective Cohort Study
Alina G Burek1,2, Tracey Liljestrom3,2, Kelsey Porada2
1Children's Hospital of Wisconsin, Milwaukee, Wisconsin; and aburek@mcw.edu.
Insights
Transitioning children to a regular diet after a nil per os (NPO) order may shorten hospital stays. Clear-liquid diets did not improve diet tolerance but were linked to longer lengths of stay (LOS).
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
- Hospital Medicine
Background:
- Clear-liquid diets are standard after nil per os (NPO) orders for pediatric acute gastrointestinal (GI) illnesses.
- The efficacy of clear-liquid diets versus immediate regular diets post-NPO is not well-established.
- Understanding optimal diet progression can impact patient outcomes and hospital resource utilization.
Purpose of the Study:
- To compare outcomes of clear-liquid diet versus regular diet after NPO in pediatric patients.
- To evaluate diet tolerance, pain, and length of stay (LOS) in children recovering from acute GI illness.
Main Methods:
- Retrospective cohort study of 39 pediatric patients (ages 1-18) admitted for acute GI illness.
- Patients received either a clear-liquid diet or a regular diet post-NPO order.
- Exclusion criteria included complex medical needs, feeding disorders, or chronic GI conditions.
Main Results:
- No significant differences in diet tolerance (emesis, pain scores, return to NPO) were observed between groups.
- Patients on a clear-liquid diet experienced a significantly longer length of stay (LOS) post-diet initiation (P=.01).
- This prolonged LOS remained significant after controlling for age, diagnosis, and pain scores (P=.03).
Conclusions:
- Clear-liquid diets after NPO status are associated with longer LOS in children without improving diet tolerance.
- Transitioning to a regular diet post-NPO may reduce LOS without adverse effects.
- Clinical practice guidelines may benefit from reassessing routine clear-liquid diet progression.
Objectives:
A clear-liquid diet is commonly used after a nil per os (NPO) order in children recovering from acute gastrointestinal (GI) illnesses. Our purpose for this study was to compare outcomes in patients receiving a clear-liquid diet after an NPO order with outcomes in those receiving a regular diet.
Methods:
In this retrospective cohort study, patients aged 1 to 18 years admitted to a tertiary care children's hospital between 2016 and 2017 were screened to identify those who had an NPO order placed for acute GI illnesses. Patients with complex medical needs, a feeding disorder, or chronic GI disorders were excluded.
Results:
Of 39 total patients, 17 (44%) received a clear-liquid diet after an NPO order. There was no difference in diet tolerance between patients receiving a clear-liquid diet and those receiving a regular diet on the basis of emesis in the first 12 hours (P = .40), pain scores after the first oral intake (P = .86), return to clear-liquid diet (P = .57), or return to NPO status (P > .99). Patients started on a clear-liquid diet had a longer length of stay (LOS) after diet initiation compared with those receiving a regular diet (median: 43.7 hours [interquartile range: 29.8-53.4] vs median: 20.8 hours [interquartile range 6.7-47.3]), both in the univariate analysis (P = .01) and after controlling for age, diagnosis category, and pain score before and after the first oral intake (P = .03).
Conclusions:
Patients transitioned to a clear-liquid diet after NPO status have a longer LOS after the first oral intake independent of patient age, diagnosis, and pretransition abdominal pain. Both groups had similar diet tolerance, suggesting that transition to a regular diet after NPO status may decrease LOS without significant adverse effects.
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