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Background Multiple surgical procedures required by patients with extensive thermal injuries impedes delivery of adequate nutrition support, leading to caloric deficits, weight loss, delayed wound healing, and increased length of stay. The standard practice at our institution for >20 years has been to continuously infuse postpyloric enteral nutrition (EN) during surgery. The purpose of this review was to examine the safety and efficacy of intraoperative EN support. Methods A retrospective chart review of pediatric patients with burn injuries >30% total body surface area provided a 20‐year (1995–2014) safety assessment associated with intraoperative feeding along with an evaluation of gastrointestinal tolerance and efficacy. Continuous variables were summarized by mean and SD, whereas categorical variables were summarized by counts and percentages. Results The 20‐year review confirmed the safety of intraoperative feeding, as the assessment of 434 patients revealed no incidence of aspiration. Patients were successfully fed during an average of 8.4 ± 6.5 surgical procedures and received EN support for a mean of 49.9 ± 31.7 days. Uninterrupted nutrition delivery was well tolerated with minimal gastrointestinal intolerance. Patients achieved an average nitrogen balance of 3.1 ± 2.8 and 70% maintained ±10% of their body weight at time of discharge. Conclusion EN has been safely provided with marginal intolerance during surgical procedures over the past 20 years. Continuous nutrition support with negligible interruption is integral to meet nutrient needs for wound healing, preservation of weight and nutrition parameters, and optimize length of stay in pediatric patients with extensive thermal injuries.

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