Early oral feeding enhanced recovery after intestinal anastomosis in young infants aged less than 3 months -A real-word study

Abstract

Background Early oral feeding(EOF) has been proven with a low incidence of complications and fast recovery after surgery in some elective pediatric patients,however,evidence for initiating EOF after intestinal anastomosis(IA) in young infants aged less than 3 months,with immature immune system and organs, is insufficient.This tudy was primary designed to investigate the status and evaluate the feasibility of EOF in young infants with IA in mainland china. Methods 491 young infants from 51 hospital in china mainland were divided into two groups(EOF group,n=88;traditional oral feeding,TOF group,n=403),and the clinical characteristics were collected and analyzed for evaluation of the status of EOF in young infants.The complications and recovery were also be compared to defined the feasibility after balancing the baseline by propensity score matching(PSM). Results The time of TPN,PN and postoperative hospital stay were significantly shorter in the EOF group than that in the TOF group in young infants with IA(2.00[1.00,2.00]d vs. 5.00[3.00,6.00]d, p<0.001; 7.00[5.00,8.00]d vs.9.00[7.00,13.00]d, p<0.001;11.00[8.00,14.00]]d vs.14.00[11.00,17.00]d).There were significant differences in the spectrum of disorders, anastomotic sites,operative age and weight between EOF and TOF groups(p=0.002;p=0.029,p=0.045,p<0.001).The overall low rate of EOF in neonates and infants with IA was 17.9%,especially lower in intestinal atresia,stenosis,stoma closure,ileal-colonic,colonic anastomotic site,operative age less than 30 days and weight less than 2.5kg.The overall rate of and Clavien-Dindo II complications were higher in EOF than TOF group(p=0.002),however,no differences were found in severe complications(Clavien-Dindo III/ IV/V). Conclusion The rate of EOF in young infants with IA is low in Mainland China and the spectrum of disorders,anastomotic sites,operative age and weight maybe factors affecting the performing of EOF. Nevertheless, implementing EOF in young infants with IA maybe beneficial, enhances the recovery, and does not increase the rate of severe complications. This study was registered on Clinical Trials. gov (NCT04464057)