Early Enteral Feeding Versus Traditional Feeding After Colostomy Closure in Paediatric Patients: A Comparative Study of Postoperative Outcome

Abstract

Abstract:Traditional practice of postoperative starvation after abdominal surgery recently has been changed. Early enteral feeding has been shown benefits in reduction of postoperative ileus and hospital stay by various clinical trials. In this study postoperative outcome was analized after colostomy closure in paediatric patients in relation to early vursus traditional enteral feeding. This is a prospective comparative study done in Dhaka Shishu (children) Hospital between January 2009 to December 2013. Total 125 patients were included and divided into two groups. Group-A (n=55) and Group-B (n=70) underwent traditional enteral feeding and early enteral feeding in post-operative period respectively. Unpaired 't' test were used for statistical analysis. Post-operative hospital stay and complications such as vomiting, diarrhoea, wound disruption were assessed. Lower gastro-intestinal bleeding, urinary tract infection (UTI), upper respiratory tract infection (URTI) and unspecified fever >48 hours were used as parameters of study. In group-B, post-operative hospital stay and complications such as vomiting, diarrhoea, wound disruption, lower G.I bleeding, UTI, URTI and unspecified fever >48 hours were significantly lesser than group-A. Parents were satisfied with early enteral feeding in post-operative period. By this study early enteral feeding patients found to be more advantageous than the traditional feeding patients undergoing colostomy closure.

Early Enteral Nutrition in Neonates Following Abdominal Surgery

“…Moore et al [4] and Paul et al [6] showed the evidence of decreased SSI with EEN. The present study showed similar results.…”

“…Enteral nutrition as a source of supply of substrate for enterocytes has been well established. EEN on newborns was shown to decrease post-operative sepsis [3][4][5][6]. The fear of aspiration, misplaced concepts of feed intolerance, and established mindset of NPO in all abdominal surgeries led to ignoring the scientific advances in understanding the role of food in maintaining the integrity of intestinal mucosa.…”

“…Many authors [5,6,[10][11][12][13] have clearly shown reduced hospital stay with EEN. The present study also showed a positive effect of EEN on hospital stay.…”

“…Luckey et al [20] Early post-operative feeding decreases post-operative ileus Sangkhathat et al [11] EEN after colostomy closure stimulated early bowel movement and reduced hospital stay with no increased adverse effects Ekingen et al [10] Early intra-gastric small volume breastfeeding well tolerated, helpful in increased wound healing and anastomosis strength decreases post-operative ileus and early first stool and reduced hospital stay. It increases splanchnic blood flow and stimulates gut immune system Many others [6,10,15,19] have clearly showed that EEN is safe and well tolerated. The present study also concurs that there were no adverse effects of EEN.…”

“…EEN with incorporation of probiotics and prebiotics is being tried by the authors now. The use of probiotics in reducing post-operative complications has been reported in literature [4][5][6]12]. EEN also facilitates early return of bowel movements [20] and thereby increases tolerance of feeds.…”