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A Standardized Post-gastrostomy Feeding Protocol for Pediatric Patients Reduces Time to Postoperative Goal Feeding

MaKayla L O'Guinn1, Olivia A Keane1, William G Lee1

  • 1Department of Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.

The American Surgeon
|April 29, 2024
PubMed

Insights

Implementing an accelerated post-gastrostomy feeding protocol significantly reduced time to goal enteral nutrition in pediatric patients. This standardized approach achieved earlier feeding without increasing postoperative complications, improving patient outcomes.

Area of Science:

  • Pediatric Surgery
  • Nutritional Support
  • Clinical Protocol Implementation

Background:

  • Gastrostomy creation is a common pediatric surgery with variable feeding initiation and advancement timelines.
  • Delays in achieving goal feeding volumes can lead to malnutrition and prolonged hospital stays.
  • A standardized, accelerated feeding protocol was hypothesized to improve outcomes.

Purpose of the Study:

  • To evaluate the effectiveness of an accelerated, standardized post-gastrostomy feeding protocol.
  • To determine if the protocol reduces time to goal feeding volumes.
  • To assess if the protocol increases postoperative complications.

Main Methods:

  • Retrospective cohort study of pediatric patients undergoing gastrostomy.
  • Comparison of pre-protocol and post-protocol implementation cohorts (1/1/2022-11/30/2023).
  • Data abstracted included comorbidities, time to feed initiation, time to goal volume, and complications.

Main Results:

  • The post-protocol cohort achieved significantly faster enteral feed initiation (5.4 vs 7.0 hrs) and goal feeding volumes (12.8 vs 26.3 hrs).
  • Despite a higher comorbidity burden in the post-protocol group, complication rates remained similar.
  • Sub-analysis in children with complex cardiac conditions showed similar benefits.

Conclusions:

  • The accelerated post-gastrostomy feeding protocol effectively and safely expedited time to goal enteral nutrition.
  • This standardized protocol can be adopted by other institutions to improve pediatric post-gastrostomy care.
  • Early achievement of nutritional goals is feasible without compromising patient safety.
Abstract

Keywords:
cardiacpediatric surgerysurgical nutritionsurgical quality

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