Wang Zhiyong,Ren Feng,Mao Jianxiong,et al.A randomized controlled study on the effectiveness and safety of early feeding after intestinal anastomosis in infants[J].Journal of Clinical Pediatric Surgery,,22():832-838.[doi:10.3760/cma.j.cn101785-202201027-007]
A randomized controlled study on the effectiveness and safety of early feeding after intestinal anastomosis in infants
- Keywords:
- Randomized Controlled Trial; Infant; Gastroenterostomy; Nutritional Support; Surgical Procedures; Operative
- Abstract:
- Objective To explore the effectiveness and safety of early feeding after intestinal resection and anastomosis in infants.Methods For this prospective randomized controlled study,clinical data were retrospectively reviewed for 86 infants undergoing stoma closure surgery from September 2018 to April 2021.They were assigned into infants with stoma due to congenital anal atresia (CAA) and infants with stoma due to neonatal necrotizing enterocolitis (NEC).And they were randomized into early feeding group (feeding at 24-48 h post-operation,n=20) and delayed feeding group (feeding at Day 5 post-operation,n=22).Age,weight,operation duration,bleeding volume,postoperative hospitalization stay,time to initial flatus/defecation and complication rate were compared between early feeding and delayed feeding groups.Results Forty-four CAA infants underwent colostomy.There were 23 in early feeding group and 21 in delayed feeding group.Mean time to initial postoperative flatus was shorter in early feeding group than that in delayed feeding group[(2.65±0.65) vs.(3.24±0.63) day,t=3.049,P<0.05].Time to initial postoperative defecation was shorter in early feeding group than that in delayed feeding group[(3.17±0.71) vs.(4.00±1.00) day,t=4.024,P<0.05].Average postoperative hospitalization stay became shortened[(8.30±1.66) vs.(11.86±3.86) day,t=4.024,P<0.05]; Average hospitalization expense declined[15 870.68(13 536.84-19 023.80) vs.18 001.86(16 466.08,23 405.25) yuan RMB,Z=-3.072,P<0.05].All 42 NEC infants underwent terminal ileostomy.There were 20 in early feeding group and 22 in delayed feeding group; Mean time to initial postoperative flatus was shorter in early feeding group than that in delayed feeding group[(2.45±0.76) vs.(3.95±0.72) day,t=6.581,P<0.05].Time to initial postoperative defecation was shorter in early feeding group than that in delayed feeding group[(3.40±0.88) vs.(4.77±0.42) day,t=6.311,P<0.05].Average postoperative hospitalization stay became shortened[(9.55±1.67) vs.(12.77±2.56) day,t=4.871,P<0.05].Average hospitalization expense decreased[17 100.53(14 193.25-22 249.19) vs.25 024.26(19 887.00-28 680.01) yuan RMB,Z=-3.072,P<0.05].Postoperative complication (n=1) occurred and there was no anastomotic leakage in early feeding group; postoperative complications (n=4) and anastomotic leakage (n=1) in delayed feeding group.Overall incidence of postoperative complications was not statistically significant between two groups (χ2=0.706,P>0.05).Feeding intolerance occurred in early feeding group (n=6) and delayed feeding group (n=1).The difference was statistically significant (χ2=4.887,P<0.05).Conclusion After bowel resection and anastomosis,early feeding can shorten the length of hospitalization stay and lower hospitalization expense.However,it does not increase the incidence of postoperative complications.As a result,long-term postoperative fasting is not required.However,time to start feeding should be formulated according to the specific surgical status of each child so as to lower the incidence of postoperative feeding intolerance.
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Memo
收稿日期:2022-1-13。
基金项目:深圳市医学重点学科项目(SZXK035)
通讯作者:麻晓鹏,Email:1345012907@qq.com