Early enteral feeding after pediatric abdominal surgery: A systematic review of the literature.

Autor: Greer D; Department of Pediatric Surgery, Sydney Children's Hospital, Randwick, NSW, Australia. Electronic address: douglas.greer@health.nsw.gov.au., Karunaratne YG; Department of Pediatric Surgery, Sydney Children's Hospital, Randwick, NSW, Australia., Karpelowsky J; Discipline of Child & Adolescent Health, Sydney Medical School, University of Sydney, NSW, Australia; Department of Pediatric Surgery, Children's Hospital at Westmead, Sydney, NSW, Australia., Adams S; Department of Pediatric Surgery, Sydney Children's Hospital, Randwick, NSW, Australia; University of New South Wales, Randwick, NSW, Australia.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2020 Jul; Vol. 55 (7), pp. 1180-1187. Date of Electronic Publication: 2019 Sep 05.
DOI: 10.1016/j.jpedsurg.2019.08.055
Abstrakt: Introduction: Traditionally enteral nutrition has been delayed following abdominal surgery in children, to prevent complications. However, recent evidence in the adult literature refutes the supposed benefits of fasting and suggests decreased complications with early enteral nutrition (EEN). This review aimed to compile the evidence for EEN in children in this setting.
Methods: Databases Pubmed, EmBase, Medline and reference lists were searched for articles containing relevant search terms according to PRISMA guidelines. First and second authors reviewed abstracts. Studies containing patients less than 18 years undergoing abdominal surgery, with feeding initiated earlier than standard practice, were included. Studies including pyloromyotomy were excluded. Primary outcome was length of stay (LOS). Secondary outcomes included time to full enteral nutrition, time to stool and postoperative complications.
Results: Fourteen articles met inclusion criteria - five on neonatal abdominal surgery, three on gastrostomy formation and six on intestinal anastomoses. There were three randomized control trials (RCTs), five cohort studies, four historical control trials, one nonrandomized trial and one case series. Nine studies showed a decreased LOS with EEN. Most studies which reported time to full enteral nutrition showed improvement with EEN; however, time to stool was similar in most studies. Postoperative complications were either decreased or not statistically different in EEN groups in all studies.
Conclusion: Studies to date in a limited number of procedures suggest EEN appears safe and effective in children undergoing abdominal surgery. Although robust evidence is lacking, there are clear benefits in LOS and time to full feeds, and no increase in complications.
Level of Evidence: IV.
(Copyright © 2019. Published by Elsevier Inc.)
Databáze: MEDLINE
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