Optimizing Perioperative Nutrition in Pediatric Populations

Abstract

Nutrition status prior to surgery and nutrition rehabilitation after surgery can affect the morbidity and mortality of pediatric patients. A comprehensive approach to nutrition in pediatric surgical patients is important and includes preoperative assessment, perioperative nutrition considerations, and postoperative recovery. A thorough nutrition assessment to identify patients who are at nutrition risk prior to surgery is important so that the nutrition status can be optimized prior to the procedure to minimize suboptimal outcomes. Preoperative malnutrition is associated with increased complications and mean hospital days following surgery. Enteral and parenteral nutrition can be used in cases where food intake is inadequate to maintain and possibly improve nutrition status, especially in the 7-10 days prior to surgery. In the perioperative period, fasting should be limited to restricting solid foods and non-human milk 6 hours prior to the procedure and allowing clear liquids until 2 hours prior to the procedure. Postoperatively, early feeding has been shown to resolve postoperative ileus earlier, decrease infection rates, promote wound healing, and reduce length of hospital stay. If nutrition cannot be provided orally, then nutrition through either enteral or parenteral means should be initiated within 24-48 hours of surgery. Practitioners should identify those patients who are at the highest nutrition risk for postsurgical complications and provide guidance for optimal nutrition during the perioperative and postoperative period.

Preliminary Study on the Feasibility of Early Feeding After General Anesthesia and Lumbar Spine Surgery in Middle-aged and Elderly Patients

“…Above gastrointestinal physiological changes are beneficial to promote the recovery of gastrointestinal function and shorten the time of exhaust and defecation. In recent years, studies have shown that early feeding after general anesthesia does not increase the incidence of postoperative complications such as nausea, vomiting, and abdominal distension [17], which is basically consistent with our results. In this paper, we found that eating 2 hours after surgery did not increase the incidence of nausea/vomiting.…”

Determinants of length of stay after pediatric liver transplantation

“…We found that overweight children experienced a shorter LOS, which may be due to residual confounding, such that overweight may confer a benefit to withstand the stressors of operative intervention in children with ESLD not accounted for by the covariates in our model. Although our findings should be interpreted cautiously given the challenges in using weight as a marker of malnutrition for individuals with ESLD and potential ascites, our findings in underweight and obese recipients suggest that multidisciplinary teams should focus their efforts on optimizing the nutritional status of underweight recipients in a clinical setting, aiming to correct any nutritional deficiencies prior to operative intervention and improve post‐operative outcomes 37,38 . Underweight infants in our study experienced a longer LOS, which may be due to a more gradual return to enteral nutrition in this young age group.…”

Diagnosis and management of Silver–Russell syndrome: first international consensus statement

“…Many children with SRS also have abnormal tooth distribution and a small mandible, which affects airway visualization and intubation 95 . Finally, young children with SRS who are malnourished might not heal well following surgery 96 . [97][98][99][100][101] .…”