The role of parenteral nutrition following surgery for duodenal atresia or stenosis
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ORIGINAL ARTICLE
The role of parenteral nutrition following surgery for duodenal atresia or stenosis M. Bishay • B. Lakshminarayanan • A. Arnaud • M. Garriboli • K. M. Cross • J. I. Curry • D. Drake E. M. Kiely • P. De Coppi • A. Pierro • S. Eaton
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Published online: 28 November 2012 Ó Springer-Verlag Berlin Heidelberg 2012
Abstract Purpose In our institution, some children routinely receive parenteral nutrition (PN) following surgery for duodenal atresia/stenosis, while others do not. Our aim was to compare growth and infection rate between these two treatment strategies. Methods This was a retrospective study of all children undergoing surgery for duodenal atresia/stenosis over 7 years. Results Of the 54 children, 19 commenced PN soon after surgery (the ‘Initial PN’ group). Of the remaining 35 children, 13 (37 %) subsequently required PN (the ‘Delayed PN’ group). The remaining 22 never received PN (the ‘Never PN’ group). The proportion of patients experiencing clinically suspected sepsis was higher in those receiving PN (‘Initial’ plus ‘Delayed’; 41 %) compared with those who never received PN (14 %; p = 0.04). The ‘Initial PN’ and ‘Never PN’ groups did not show a significant change in weight Z score over time. However, the ‘Delayed PN’ group showed a significant decrease in weight Z scores from the time of operation to the time of achieving full enteral feeds, and failed to catch up by the time of last follow-up. Conclusion Children with duodenal atresia/stenosis can be managed without PN. However, a third of these children subsequently require PN, lose weight centiles, and have a high rate of sepsis.
M. Bishay B. Lakshminarayanan A. Arnaud M. Garriboli K. M. Cross J. I. Curry D. Drake E. M. Kiely P. De Coppi A. Pierro S. Eaton (&) Surgery Unit, Department of Paediatric Surgery, UCL Institute of Child Health and Great Ormond Street Hospital for Children, 30 Guilford Street, London WC1N 1EH, UK e-mail: [email protected]
Keywords Duodenal atresia Duodenal stenosis Parenteral nutrition Duodenal obstruction Neonatal surgery Growth
Introduction Surgery for duodenal atresia/stenosis is followed by a variable period of postoperative ileus. Different methods of postoperative nutrition are used by different surgeons. Some surgeons commence all infants on parenteral nutrition (PN) soon after surgery, whereas other surgeons do not routinely commence infants on PN with the anticipation that there will only be a short period before enteral feeds can be tolerated. In our institution, some children routinely receive PN, while others do not, and are maintained on peripheral intravenous fluids while enteral nutrition is commenced via nasogastric tube soon after surgery and increased as tolerated. We hypothesised that growth and infection rate might differ depending on the use and timing of PN in these infants.
Methods This was an institutionally approved single centre retrospective comparative cohort study. We studied 54 consecutive children undergoing surgery for duodenal atresia/ stenosis be
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