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Early Enteral Nutrition Following Gastrointestinal Surgery in Children: A Systematic Review of the Literature
Sarah Braungart1, Sotirios Siminas
1Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
Insights
Early enteral nutrition after pediatric gastrointestinal surgery is safe, with no increased risk of major complications compared to traditional feeding. Further research is needed to confirm benefits and costs.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Nutrition
Background:
- Prolonged postoperative fasting is traditional after pediatric GI surgery.
- Early feeding benefits adults, improving outcomes and hospital stay.
- Evidence for early feeding in pediatric GI surgery is limited.
Purpose of the Study:
- To evaluate the safety and effectiveness of early enteral feeding versus traditional feeding in children post-GI anastomosis.
- To synthesize current pediatric literature on this topic.
Main Methods:
- Comprehensive literature search (PubMed, Ovid, Embase) following PRISMA guidelines.
- Included studies assessed using MINORS criteria.
- Synthesized outcomes: time to feeds, discharge, and major complications.
Main Results:
- Ten studies (451 patients) analyzed; most focused on early feeding safety.
- Early feeding (≤24 hours) significantly reduced time to first feed.
- No significant differences in time to full feeds, hospital stay, or major complications (bowel obstruction, anastomotic breakdown).
Conclusions:
- Early enteral nutrition is not clearly disadvantageous after elective pediatric GI surgery.
- Current evidence suggests no clear advantage to prolonged fasting.
- Larger randomized controlled trials are needed to assess true impact on complications, costs, and patient-reported outcomes.
Objective:
To investigate the safety and effectiveness of early enteral feeding versus traditional enteral feeding after gastrointestinal (GI) anastomosis in children in the pediatric literature.
Summary Of Background Data:
Prolonged postoperative fasting has been the traditional model of care following pediatric GI surgery. In contrast, early feeding has become well established in the adult population, where meta-analyses have shown early introduction of enteral feeds to be beneficial to hospital stay and patient outcomes.
Methods:
Comprehensive literature searches of the English literature search (PubMed, Ovid, Embase databases) from inception to present according to the PRISMA guidelines. Included studies were assessed according to the MINORS criteria. Outcomes for time to first feed and full feeds, and discharge, and risk of major complications were synthesized.
Results:
Ten studies comprising 451 patients were included in the analysis. All studies aimed at investigating the safety of early feeding in pediatric GI surgery, with or without a fast-track program. Only 4 studies compared the study group to a control group in which patients were fed in a traditional way (traditional feeding).Most studies defined early feeding as feeds commenced ≤24 hours postoperatively (range 2-72 hours). Mean time to first feed was significantly lower in the early feeding group, but not significantly lower for the mean time to full feeds and mean hospital stay. Bowel obstruction and anastomotic breakdown were classed as major complications. There was no significant difference in their occurrence in both groups.
Conclusions:
Although the studies identified are few and heterogeneous, they demonstrate that there is no clear advantage of keeping children "nil by mouth" and no clear disadvantage of providing early enteral nutrition following elective gastrointestinal surgery. Larger randomized controlled trials are required to assess the true impact on postoperative complications, health care associated costs, and to investigate patient-reported outcome measures.
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