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Perioperative nutrition in the setting of pediatric inflammatory bowel disease
Jonathan Wong1, John Densmore2, Julia Hilbrands3
1Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA.
Insights
Perioperative nutrition support for pediatric inflammatory bowel disease (IBD) surgery patients is crucial. Supplemental nutrition use decreased post-surgery, despite persistent malnutrition, highlighting the need for a dedicated pediatric IBD nutrition protocol.
Area of Science:
- Pediatric Gastroenterology
- Surgical Nutrition
- Inflammatory Bowel Disease (IBD) Management
Background:
- Optimizing nutrition before surgery can improve outcomes for pediatric patients with inflammatory bowel disease (IBD).
- Perioperative nutrition status and management in children undergoing intestinal resection for IBD require assessment.
Purpose of the Study:
- To evaluate the perioperative nutrition status of pediatric patients undergoing intestinal resection for IBD.
- To assess the methods of nutrition provision for these patients.
Main Methods:
- Retrospective analysis of pediatric IBD patients undergoing primary intestinal resection.
- Identification of malnutrition using established criteria.
- Documentation of nutrition provision (preoperative, admission, postoperative) for elective and urgent cases.
- Recording of postsurgical complications.
Main Results:
- 40% of 84 pediatric IBD patients (mean age 14.5 years) were malnourished preoperatively.
- Malnutrition prevalence was similar in urgent (48%) and elective (36%) surgical cohorts.
- Postoperatively, BMI z scores improved, but malnutrition prevalence remained unchanged (40%).
- Supplemental nutrition use decreased from 34% preoperatively to 17% postoperatively.
- Complications were not associated with nutrition status.
Conclusions:
- Supplemental nutrition utilization declined post-surgery, despite no change in malnutrition rates.
- Findings support the development of a pediatric-specific perioperative nutrition protocol for IBD surgery.
- Standardized nutrition management is essential for improving outcomes in pediatric IBD surgical patients.
Background:
Optimization of nutrition prior to inflammatory bowel disease (IBD)-related surgery could improve outcomes. The aim of this study was to assess the perioperative nutrition status and management of children undergoing intestinal resection for treatment of their IBD.
Methods:
We identified all patients with IBD who underwent primary intestinal resection. We identified malnutrition using established criteria and methods of nutrition provision at various time points (preoperative outpatient evaluation, admission, and postoperative outpatient follow-up) for elective cases (who underwent their procedure at a scheduled admission) and urgent cases (who underwent an unplanned surgical intervention). We also recorded data on postsurgical complications.
Results:
A total of 84 patients were identified in this single-center study (male sex: 40%, mean age: 14.5 years, Crohn's disease: 65%). Thirty-four patients (40%) had some degree of malnutrition. Prevalence of malnutrition in the urgent and elective cohorts was similar (48% vs 36%; P = 0.37). Of these patients, 29 (34%) were noted to be on some type of nutrition supplementation prior to surgery. Postoperatively, BMI z scores increased (-0.61 vs -0.42; P = 0.0008), but the percentage of patients who were malnourished did not change from preoperative status (40% vs 40%; P = 0.10). Despite this, use of nutrition supplementation was only noted in 15 (17%) patients at postoperative follow-up. Complications were not associated with nutrition status.
Conclusion:
Utilization of supplemental nutrition decreased postprocedure despite no change in malnutrition prevalence. These findings support the development of a pediatric-specific perioperative nutrition protocol in the setting of IBD-related surgery.
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