Early enteral feeding after intestinal anastomosis in children: a systematic review and meta-analysis of randomized controlled trials
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Published on: April 17, 2020
Yuxin Tian1,2, Haitao Zhu1,2,3,4, Brian C Gulack3,5
1Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China.
Insights
Early enteral feeding (EEF) in children after intestinal surgery is safe and beneficial. It speeds bowel function recovery, reduces hospital stays and surgical infections without increasing complications like anastomotic leaks.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Nutrition
Background:
- Delayed enteral feeding (DEF) is associated with postoperative complications in children undergoing intestinal surgery.
- Evidence suggests early enteral nutrition benefits adults post-intestinal surgery.
- The efficacy of early enteral feeding (EEF) in pediatric patients with intestinal anastomosis requires evaluation.
Purpose of the Study:
- To evaluate the benefits of EEF versus DEF in pediatric patients after intestinal anastomosis.
- To assess the impact of EEF on postoperative complications and recovery metrics.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched MEDLINE, PubMed, Cochrane Library, and Web of Science for studies on EEF (before postoperative day 3) in children (<18 years) undergoing intestinal anastomosis.
- Meta-analysis performed using RevMan 5.3 to calculate odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs).
Main Results:
- Four RCTs involving 97 EEF cases and 89 DEF cases were analyzed.
- EEF significantly reduced length of hospital stay (MD = -3.38 days) and time to bowel movement return (MD = -0.57 days).
- EEF led to a lower incidence of surgical infection (OR = 0.27) and faster tolerance of full enteral feeding (MD = -2.00 days), with no significant difference in anastomotic leak rates (OR = 0.86).
Conclusions:
- EEF in children after intestinal anastomosis does not increase risks of anastomotic leak, fever, emesis, or abdominal distention.
- EEF is beneficial, promoting faster bowel function recovery, shorter hospital stays, and reduced surgical infection rates compared to DEF.
Purpose:
Delayed enteral feeding (DEF) contributes to postoperative complications among children undergoing intestinal surgery. Various recent studies indicate the benefits of early enteral nutrition after intestinal surgery in adults. This systematic review and meta-analysis evaluates whether early enteral feeding (EEF) is beneficial in children who underwent intestinal anastomosis.
Methods:
MEDLINE, PubMed, the Cochrane Library, and Web of Science databases were searched for RCTs that addressed the effect of EEF in children (younger than 18 years old) undergoing intestinal anastomosis. EEF was defined as starting enteral feeding before the 3rd postoperative day. Studies were selected based on predetermined inclusion and exclusion criteria. A meta-analysis was performed using RevMan 5.3 to estimate odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs).
Results:
Four RCT studies met the inclusion criteria, comprising 97 cases with EEF and 89 cases with DEF. Enteral feeding started significantly earlier in the EEF group compared to the DEF group (MD = - 2.80; 95% CI - 3.11 to - 2.49; p < 0.00001). Postoperative anastomotic leak rate was unchanged between EEF and DEF groups (OR = 0.86; 95% CI 0.17-4.46; p = 0.86). The EEF group had a shorter length of hospital stay (MD = - 3.38; 95% CI - 4.29 to - 2.48; p < 0.00001), earlier time to bowel movement return (MD = - 0.57; 95% CI - 0.79 to - 0.35; p < 0.00001), lower incidence of surgical infection (OR = 0.27; 95% CI 0.08-0.90; p = 0.03), and faster tolerance of full enteral feeding (MD = - 2.00; 95% CI - 3.01 to - 2.79; p < 0.00001). Incidence of fever (OR = 0.37; 95% CI 0.10-1.31; p = 0.12), emesis, and abdominal distention (OR = 0.63; 95% CI 0.13-3.16; p = 0.58) were not different between the two groups.
Conclusions:
Early enteral feeding after intestinal anastomosis in children does not increase the risk of postoperative anastomotic leak, fever, emesis, and abdominal distention. However, early enteral feeding is beneficial as it promotes the return of bowel function, reduces the length of hospital stay and the incidence of surgical infection in comparison to delayed enteral feeding.
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