Lu Changgui, Sun Xinhe, Geng Qiming, Tang Weibing
Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China.
Nanjing Medical University, Nanjing, China.
Front Nutr. 2023 Jul 20;10:1185876. doi: 10.3389/fnut.2023.1185876. eCollection 2023.
To prevent postoperative complications, delayed oral feeding (DOF) remains a common model of care following pediatric intestinal anastomosis surgery; however, early oral feeding (EOF) has been shown to be safe and effective in reducing the incidence of complications and fast recovery after pediatric surgery. Unfortunately, the evidence in support of EOF after intestinal anastomosis (IA) in infants is insufficient. Therefore, this study was primarily designed to evaluate the safety and efficacy of EOF. In addition, the current status of EOF application and associated factors that favor or deter EOF implementation were also assessed.
A total of 898 infants were divided into two groups (EOF group, = 182; DOF group, = 716), and the clinical characteristics were collected to identify the factors associated with EOF in infants. Complications and recovery were also compared to define the safety and efficacy after balancing the baseline data by propensity score matching (PSM) (EOF group, = 179; DOF group, = 319).
The total EOF rate in infants with IA was 20.3%. Multivariate logistic regression revealed significant differences in the EOF rates based on IA site and weight at the time of surgery (OR = 0.652, 95% CI: 0.542-0.784, < 0.001) and (OR = 1.188, 95% CI: 1.036-1.362, = 0.013), respectively. The duration of total parenteral nutrition (TPN), parenteral nutrition (PN), and postoperative hospital stay were significantly shorter in the EOF group than the DOF group [2.0 (1.0, 2.0) d vs. 5.0 (3.0, 6.0) d; 6.0 (5.0, 8.0) d vs. 8.0 (6.0, 11.0) d; 10.0 (7.0, 14.0) d vs. 12.0 (9.0, 15.0) d, all < 0.001]. The rates of abdominal distension and vomiting in the EOF group were significantly higher than the DOF group (17.9% vs. 7.2%, < 0.001; 7.8% vs. 2.5%, = 0.006); however, no differences were found in failure to initial OF, diarrhea, hematochezia, and anastomotic leakage between the two groups ( > 0.05).
The overall rate of EOF in infants following IA was low, and the sites of anastomosis and weight at surgery were two factors associated with EOF. Nevertheless, performing EOF in infants after IA was safe and effective, reduced PN usage, shortened the hospital stay, and did not increase the rate of severe complications.: ClinicalTrails.gov, identifier NCT04464057.
为预防术后并发症，延迟经口喂养（DOF）仍是小儿肠吻合术后常用的护理模式；然而，早期经口喂养（EOF）已被证明在降低小儿手术后并发症发生率和促进快速恢复方面是安全有效的。不幸的是，支持婴儿肠吻合术（IA）后进行EOF的证据不足。因此，本研究主要旨在评估EOF的安全性和有效性。此外，还评估了EOF应用的现状以及有利于或阻碍EOF实施的相关因素。
总共898名婴儿被分为两组（EOF组，n = 182；DOF组，n = 716），收集临床特征以确定与婴儿EOF相关的因素。还比较了并发症和恢复情况，通过倾向评分匹配（PSM）平衡基线数据后确定安全性和有效性（EOF组，n = 179；DOF组，n = 319）。
IA婴儿的总EOF率为20.3%。多因素逻辑回归显示，基于IA部位和手术时体重的EOF率存在显著差异（OR = 0.652，95%CI：0.542 - 0.784，P < 0.001）和（OR = 1.188，95%CI：1.036 - 1.362，P = 0.013）。EOF组的全胃肠外营养（TPN）、胃肠外营养（PN）持续时间和术后住院时间均显著短于DOF组[2.0（1.0，2.0）天对5.0（3.0，6.0）天；6.0（5.0，8.0）天对8.0（6.0，11.0）天；10.0（7.0，14.0）天对12.0（9.0，15.0）天，均P < 0.001]。EOF组的腹胀和呕吐发生率显著高于DOF组（17.9%对7.2%，P < 0.001；7.8%对2.5%，P = 0.006）；然而，两组在初次经口喂养失败、腹泻、便血和吻合口漏方面未发现差异（P > 0.05）。
IA后婴儿的总体EOF率较低，吻合部位和手术时体重是与EOF相关的两个因素。尽管如此，IA后婴儿进行EOF是安全有效的，减少了PN的使用，缩短了住院时间，且未增加严重并发症的发生率。：ClinicalTrails.gov，标识符NCT04464057。
