A pre and post interventional audit of an 'apple juice on arrival' protocol to reduce excessive clear fluid fasting times in paediatric patients

Area of Science:

• Pediatric Anesthesiology
• Perioperative Medicine
• Pediatric Surgery

Background:

• Prolonged preoperative fasting in children is linked to adverse metabolic and behavioral outcomes.
• Existing pediatric preoperative clear fluid fasting guidelines (2 hours) were not always adhered to, leading to extended fasting durations for some patients.

Purpose of the Study:

• To audit pediatric fasting times before and after implementing an 'apple juice on arrival' protocol.
• To evaluate the impact of the new protocol on clear fluid fasting duration and preoperative blood glucose levels in children.

Main Methods:

• A prospective audit was conducted over two 4-week periods, before and after protocol implementation.
• The 'apple juice on arrival' protocol involved administering 3 ml/kg of apple juice to children upon arrival at the children's ward.
• Data collected included fasting times (solids and clear fluids), capillary blood glucose levels, and parental knowledge of fasting requirements.

Main Results:

• Clear fluid fasting times decreased significantly from an average of 9.9 hours pre-intervention to 3.5 hours post-intervention (P < 0.01).
• Mean preoperative blood glucose levels increased from 4.9 mmol/L to 5.6 mmol/L post-intervention (P < 0.001).
• The study included 39 children in the pre-intervention group and 40 in the post-intervention group.

Conclusions:

• The 'apple juice on arrival' protocol effectively reduced clear fluid fasting times in pediatric patients.
• This intervention appears to be a safe and practical method to improve perioperative fasting management in children.
• The protocol contributed to better preoperative glycemic status, potentially mitigating risks associated with prolonged fasting.