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The Safety and Efficacy of Early Enteral Nutrition After Paediatric Enterostomy Closure - The EPOC Study
James Cope1, Douglas Greer2, Soundappan S V Soundappan3
1Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of NSW, Kensington, NSW, 2033, Australia.
Insights
Early enteral nutrition (EEN) after intestinal stoma closure significantly reduces hospital stay and speeds recovery. This safe approach allows children to resume feeding sooner, improving outcomes without increasing complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Nutrition
Background:
- Traditional practice involves prolonged fasting after intestinal stoma closure, risking malnutrition.
- Early enteral nutrition (EEN) is proposed as a safer alternative to reduce complications associated with delayed feeding.
Purpose of the Study:
- To evaluate the efficacy and safety of initiating early enteral nutrition (EEN) in pediatric patients following intestinal stoma closure.
Main Methods:
- Retrospective cohort study of 69 children (3 months–16 years) undergoing intestinal stoma closure.
- Comparison between early enteral nutrition (EEN) within 24 hours and later enteral nutrition (LEN).
- Primary outcome: length of post-operative stay (LOS); secondary outcomes: time to feeds, time to stool, complications.
Main Results:
- Children in the EEN group had a significantly shorter LOS (92.6 h vs 121.7 h).
- EEN was associated with decreased time to free fluids and full enteral intake.
- No significant difference in post-operative complications between EEN and LEN groups.
Conclusions:
- Initiating feeding within 24 hours of stoma closure is effective and safe.
- EEN leads to reduced LOS, faster feeding resumption, and quicker return of bowel function.
- Further research is recommended for broader population applicability.
Introduction:
Keeping children nil by mouth until return of bowel function after intestinal anastomosis surgery is said to reduce complications. Fasting may extend up to five days, risking malnourishment and usage of parenteral nutrition. This study aims to establish the efficacy and safety of early enteral nutrition in children undergoing intestinal stoma closure.
Methodology:
A retrospective cohort study of children aged three months to 16 years who underwent an intestinal stoma closure between 1/1/2019 and 31/12/2021 at two tertiary paediatric hospitals was undertaken. Children fed clear fluids within 24 h (EEN) were compared to those commencing feeds later (LEN). The primary outcome was length of post-operative stay (LOS) and secondary outcomes included: time to feeds; time to stool; and complications.
Results:
Of the 129 children that underwent a stoma closure, 69 met inclusion criteria: 35 (51 %) in the LEN group and 34 (49 %) in the EEN group. Children in the EEN group had a significantly shorter LOS (92.6 h vs 121.7 h, p = 0.0045). Early feeding was also associated with a significantly decreased time to free fluids (p < 0.001) and full enteral intake (p = 0.007). There was no significant intergroup difference in complications.
Conclusion:
Commencing feeding within 24 h of stoma closure is efficacious and safe, with clear reductions in LOS, time to full feeds and time to stool, and no increase in complications. Further research is required to extrapolate these findings to other populations.
Level Of Evidence:
III.
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