Li Jiahua,Peng Yanfen,Lyu Junjian,et al.Effect of early enteral nutrition on enhanced recovery after surgery for severe jejunoileal atresia[J].Journal of Clinical Pediatric Surgery,,22():813-817.[doi:10.3760/cma.j.cn101785-202305043-003]
Effect of early enteral nutrition on enhanced recovery after surgery for severe jejunoileal atresia
- Keywords:
- Intestinal Atresia; Enhanced Recovery After Surgery; Nutritional Support; Surgical Procedures; Operative; Child
- Abstract:
- Objective To evaluate the effect of early enteral nutrition (EN) on enhanced recovery after surgery (ERAS) for severe jejunoileal atresia (JIA).Methods From January 2018 to December 2022,clinical data were retrospectively reviewed for 92 neonates of severe JIA.They were assigned into two groups of early feeding (n=39) and conventional feeding (n=53) based upon the time of initial postoperative feeding.General profiles,time to achieve full feeding,length of hospitalization,incidence of complications and feeding intolerance were compared between two groups.Results Time to initial postoperative feeding was significantly shorter in early feeding group than that in conventional feeding group[2.0(1.0,2.0) vs.7.0 (5.0,13.0) day](P<0.05).Time to achieve full feeding in two group was 20.0(10.0,34.0) and 21.0(15.0,33.0) day and postoperative length of stay 26.0(15.0,37.0) and 25.0 (17.0,43.0) day.Anastomotic leakage occurred (n=5 vs.n=4).There were peritonitis (n=5 vs.n=3),postoperative neonatal necrotizing enterocolitis (n=3 vs.n=3),gastrointestinal hemorrhage (n=2 vs.n=2) and cholestasis (n=7 vs.n=10).There were unplanned re-surgeries (n=4 vs.n=7) and duration of parenteral nutrition [18.0(12.0,32.0) vs.19.0(13.0,34.0) day].No death occurred in neither groups within 30 days,except for 1 case in early feeding group.The incidence of readmission within 30 days was (n=1 vs.n=2).There was no significant inter-group statistical difference (P>0.05).There were abdominal distension (n=5 vs.n=4),recurrent vomiting (n=22 vs.n=24),repeated fasting (n=25 vs.n=30) and repeated gastric decompression (n=23 vs.n=27).There were no statistically significant differences (P>0.05).Conclusion Early EN after intestinal anastomosis is safe for severe jejunoileal atresia.However,there is no clear advantage for reverse proximal hypomotility.
References:
[1] Peng YF,Zheng HQ,Zhang H,et al.Comparison of outcomes following three surgical techniques for patients with severe jejunoileal atresia[J].Gastroenterol Rep (Oxf),2019,7(6):444-448.DOI:10.1093/gastro/goz026.
[2] Lee SH,Cho YH,Kim HY,et al.Clinical experience of complex jejunal atresia[J].Pediatr Surg Int,2012,28(11):1079-1083.DOI:10.1007/s00383-012-3131-5.
[3] Aarts MA,Rotstein OD,Pearsall EA,et al.Postoperative ERAS interventions have the greatest impact on optimal recovery:experience with implementation of ERAS across multiple hospitals[J].Ann Surg,2018,267(6):992-997.DOI:10.1097/SLA.0000000000002632.
[4] Mahmoodzadeh H,Shoar S,Sirati F,et al.Early initiation of oral feeding following upper gastrointestinal tumor surgery:a randomized controlled trial[J].Surg Today,2015,45(2):203-208.DOI:10.1007/s00595-014-0937-x.
[5] Zangheri G,Andreani M,Ciriello E,et al.Fetal intra-abdominal calcifications from meconium peritonitis:sonographic predictors of postnatal surgery[J].Prenat Diagn,2007,27(10):960-963.DOI:10.1002/pd.1812.
[6] 吕俊健,彭艳芬,张红,等.不同手术方式治疗难治型先天性小肠闭锁的预后分析[J].中华新生儿科杂志(中英文),2019,34(3):172-176.DOI:10.3760/cma.j.issn.2096-2932.2019.03.003. Lyu JJ,Peng YF,Zhang H,et al.Outcomes of different surgical procedures for persistent jejunoileal atresia[J].Chin J Neonatol (Chinese-English),2019,34(3):172-176.DOI:10.3760/cma.j.issn.2096-2932.2019.03.003.
[7] Tang Z,Cai HF,Cui YB.Influence of early postoperative feeding in gastrointestinal anastomotic fistula formation and healing time in rabbits[J].Biomed Res Int,2018,2018:8258096.DOI:10.1155/2018/8258096.
[8] Ekingen G,Ceran C,Guvenc BH,et al.Early enteral feeding in newborn surgical patients[J].Nutrition,2005,21(2):142-146.DOI:10.1016/j.nut.2004.10.003.
[9] Yadav PS,Choudhury SR,Grover JK,et al.Early feeding in pediatric patients following stoma closure in a resource limited environment[J].J Pediatr Surg,2013,48(5):977-982.DOI:10.1016/j.jpedsurg.2013.02.013.
[10] Lassen K,Kjaeve J,Fetveit T,et al.Allowing normal food at will after major upper gastrointestinal surgery does not increase morbidity:a randomized multicenter trial[J].Ann Surg,2008,247(5):721-729.DOI:10.1097/SLA.0b013e31815cca68.
[11] Lubawski J,Saclarides T.Postoperative ileus:strategies for reduction[J].Ther Clin Risk Manag,2008,4(5):913-917.DOI:10.2147/tcrm.s2390.
[12] Wang XL,Yuan CD,Xiang L,et al.The clinical significance of pathological studies of congenital intestinal atresia[J].J Pediatr Surg,2013,48(10):2084-2091.DOI:10.1016/j.jpedsurg.2013.05.025.
[13] 吕小逢,徐小群,耿其明,等.新生儿高位消化道畸形术后早期肠内营养的可行性[J].中华临床营养杂志,2014,22(1):23-27.DOI:10.3760/cma.j.issn.1674-635X.2014.01.005. Lyu XF,Xu XQ,Geng QM,et al.Feasibility of early enteral nutrition after surgery for upper digestive tract malformation in neonates[J].Chin J Clin Nutr,2014,22(1):23-27.DOI:10.3760/cma.j.issn.1674-635X.2014.01.005.
[14] 陈焕,耿其明,路长贵,等.肠折叠术联合早期肠内营养在空肠闭锁患儿加速康复外科中的应用[J].中华胃肠外科杂志,2017,20(5):535-539.DOI:10.3760/cma.j.issn.1671-0274.2017.05.012. Chen H,Geng QM,Lu CG,et al.Application of bowel plication plus early enteral nutrition during enhanced recovery after surgery for neonates with jejunal atresia[J].Chin J Gastrointest Surg,2017,20(5):535-539.DOI:10.3760/cma.j.issn.1671-0274.2017.05.012.
[15] Grass F,Hübner M,Lovely JK,et al.Ordering a normal diet at the end of surgery-justified or overhasty?[J].Nutrients,2018,10(11):1758.DOI:10.3390/nu10111758.
[16] Petrelli NJ,Cheng C,Driscoll D,et al.Early postoperative oral feeding after colectomy:an analysis of factors that may predict failure[J].Ann Surg Oncol,2001,8(10):796-800.DOI:10.1007/s10434-001-0796-8.
[17] Slim K,Reymond T,Joris J,et al.Intolerance to early oral feeding in enhanced recovery after colorectal surgery:an early red flag?[J].Colorectal Dis,2020,22(1):95-101.DOI:10.1111/codi.14785.
[18] 吴晓霞,任红霞,詹江华.新生儿肠闭锁术后早期肠内营养发生坏死性小肠结肠炎的诊疗分析[J].中华小儿外科杂志,2019,40(4):324-327.DOI:10.3760/cma.j.issn.0253-3006.2019.04.008. Wu XX,Ren HX,Zhan JH.Necrotizing enterocolitis after enteral nutrition for neonates with congenital intestinal atresia[J].Chin J Pediatr Surg,2019,40(4):324-327.DOI:10.3760/cma.j.issn.0253-3006.2019.04.008.
Memo
收稿日期:2023-5-26。
基金项目:广东省医学科学技术研究基金项目(A2020076);广州市科技创新发展专项资金项目(基础与应用基础研究项目)(202102080511)
通讯作者:何秋明,Email:qiuminghe@foxmail.com