Early Enteral Nutrition in Neonates Following Abdominal Surgery

Abstract

Introduction: Nil per oral (NPO)/nil by mouth has been the most commonly practiced convention in post-operative period. Misplaced fear of aspiration led to routine prescription of “NPO.” Starvation leads to atrophy of the gut mucosa leading to decreased barrier effect of gut mucosa. This starvation-induced gut mucosal injury increases septic complications and mortality. The study aims at establishing the feasibility and effect of early enteral nutrition (EEN) in neonates following abdominal surgeries.Materials and Methods: A total of 260 cases formed the cohort of prospective cohort study, 79 in EEN - Group “A” and 181 in NPO - Group “B.” Effect of EEN was evaluated with regard to outcome, hospital stay, surgical site infections (SSI), stress markers such as C-reactive protein (CRP), procalcitonin, tumor necrosis factor alpha (TNF α), and neonatal-predisposition, insult/injury, response, organ failure (Neo-PIRO) scores, intra-abdominal pressure (IAP) grade, tolerance of feeds, and time to first stool. Chi-square was the statistical method used. Epi info version 7 was the software used.Results: Group B had higher mortality (20.09%) than Group A (P < 0.05). 33.7 in Group B developed SSI, of which 90% were deep and intracavitary (P < 0.05). Hospital stay was less in Group A (P < 0.05). CRP and Neo-PIRO scores were less in Group A compared to Group B (P < 0.05). TNF-α expression and IAP scores were not statistically significant (P > 0.05). Procalcitonin levels were higher in Group B. Feeds were better tolerated in Group A. First stool appeared earlier in Group A than B. There was no difference in anastomotic leak in both the groups.Conclusion: EEN in neonates following abdominal surgeries is feasible, well tolerated reduces the hospital stay and mortality, and reduces SSIs, and early gut motility could be established.

Consensus Guidelines for Perioperative Care in Neonatal Intestinal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations

“…There is high‐quality evidence to support early enteral feeding in post‐surgical neonates. Neonates that were fed early have a shorter LOS, and decreased SSIs with no increase in anastomotic leaks [63, 64]. Additionally, in very low birth weight infants, the early introduction of low volume feeds showed no increased incidence of NEC and a decreased incidence of sepsis [65, 66].…”

Recommendations for the Multidisciplinary Management of Neonates With Congenital Intestinal Surgical Pathology (The First Paediatric Guidelines From the Eras® Society)

“…Існують високого рівня якості докази щодо користі раннього початку харчування у прооперованих новонароджених. У дослідженнях було показано, що у новонароджених, яких починали годувати рано, строки перебування в стаціонарі були коротшими, а частота інфікування рани та неспроможності анастомозів були нижчими [23]. Крім того, у дітей з низькою при народженні масою тіла годування малими об'ємами не призводило до збільшення випадків виникнення некротизуючого ентероколіту, а також знижувало частоту розвитку сепсису [20].…”

The Effect of Early Enteral Feeding on Neonatal Outcome After Gastrointestinal Tract Surgery In Assiut University Children Hospital

“…There are many reasons for Gastrointestinal tract ( GIT ) surgery and the aim after surgery is to establish infants on enteral feeding ( EF ) and wean them off of TPN. The fear of aspiration, prevent nausea, vomiting and anastomotic complications led to routine prescription of "Nothing per oral / nil by mouth" [1] The duration of postoperative fasting is variable and can range from 0 to 5 days depending on the operation. This period of fasting may prolong length of hospital stays ( LOHS ), increase use of TPN, social effects and signi cant costs to the health system.…”