Feeding Post-Pyloromyotomy: A Meta-analysis

Abstract

CONTEXT: Postoperative emesis is common after pyloromyotomy. Although postoperative feeding is likely to be an influencing factor, there is no consensus on optimal feeding. OBJECTIVE: To compare the effect of feeding regimens on clinical outcomes of infants after pyloromyotomy. DATA EXTRACTION: Data were extracted on methodological quality, general study and intervention characteristics, and clinical outcomes.RESULTS: Fourteen studies were included. Ad libitum feeding was associated with significantly shorter length of stay (LOS) when compared with structured feeding (mean difference [MD] −4.66; 95% confidence interval [CI], −8.38 to −0.95; P = .01). Although gradual feeding significantly decreased emesis episodes (MD −1.70; 95% CI, −2.17 to −1.23; P < .00001), rapid feeding led to significantly shorter LOS (MD 22.05; 95% CI, 2.18 to 41.93; P = .03). Late feeding resulted in a significant decrease in number of patients with emesis (odds ratio 3.13; 95% CI, 2.26 to 4.35; P < .00001).LIMITATIONS: Exclusion of non-English studies, lack of randomized controlled trials, insufficient number of studies to perform publication bias or subgroup analysis for potential predictors of emesis.CONCLUSIONS: Ad libitum feeding is recommended for patients after pyloromyotomy as it leads to decreased LOS. If physicians still prefer structured feeding, early rapid feeds are recommended as they should lead to a reduced LOS.

The Impact of Early Enteral Nutrition on Post-operative Hospital Stay and Complications in Infants Undergoing Congenital Cardiac Surgery: A Systematic Review and Meta-analysis

“… 33 In recent meta-analysis reported that EEN within 48 hours post gastro intestine anastomosis significantly reduced ICU stay, mechanical ventilation supports and reduced the post-operative complications in infants. 28 However, the findings of our review, similar to previous systematic review and meta-analysis, have reported on pyloromyotomy 34 and abdominal surgery in children, 35 with EEN declined hospital stay, ICU stay and postoperative complications in infants.…”

Idiopathic Hypertrophic Pyloric Stenosis with Complete Ladd's Band: A Rare Association

“…In a meta-analysis, infants offered feedings 4 hours after operation tolerated full feedings sooner and had a shorter hospital stay compared with infants receiving an incremental feeding schedule, despite having more emesis episodes. 12 13 14 Radiologic evaluation should be performed if vomiting persists beyond 5 days postoperatively, 9 with the understanding that interpretation of the study may be difficult because of postoperative swelling. 11 We did a contrast study to the patient where it showed a delay in the passage of the contrast to the small intestine.…”

Enhanced recovery after surgery in paediatrics: a review of the literature

“…Although emesis was more likely in infants on a rapid than a gradual feeding regime, emesis was not found to have a negative effect on overall patient outcome. 27 Even for neonatal patients after intestinal resection, early feeding has been associated with a shorter LOS and decreased time until first stool. Early postoperative feeding may not be appropriate for all patients; for example infants who have undergone post bowel resection for volvulus or necrotising enterocolitis with ischaemic bowel may require a different approach.…”