Impact of Early Enteral Feeding on Recovery after Paediatric Gastrointestinal Surgery

Abstract

Background: Traditional postoperative management after paediatric gastrointestinal surgery has frequently involved withholding oral or enteral nutrition until clinical evidence of bowel function appears. There is recent evidence that early enteral feeding can help to hasten gastrointestinal recovery without increasing major surgical complications.

Objective: To determine the impact of early enteral feeding on postoperative recovery, feeding tolerance, complications, and length of hospital stay in children undergoing gastrointestinal surgery.

Methods: This is a prospective comparative cohort study carried out at MTI Khyber Teaching Hospital Peshawar from July 2023 to June 2024. Total number of children included were 150 who were having gastrointestinal surgery. In 75 patients, enteral feeding was started early (within 24 hours after surgery), and in 75 patients, enteral feeding was delayed (48 hours or after clinical evidence of bowel recovery). Medical data including demographic, operative, feeding, recovery and postoperative complications were collected and analyzed on both groups.

Results: The mean time to initiation of feeding was 19.6±4.8 hours in the early-feeding group compared with 62.4±15.7 hours in the delayed-feeding group (p<0.001). The early-feeding group demonstrated earlier bowel movement (38.2±12.6 vs 55.8±16.9 hours; p<0.001), earlier achievement of full enteral nutrition (3.1±1.0 vs 5.0±1.3 days; p<0.001), and a shorter hospital stay (5.8±1.9 vs 8.2±2.6 days; p<0.001). Overall postoperative complications occurred in 13.3% of early-fed children compared with 28.0% of delayed-fed children (p=0.043). There was no significant difference in vomiting, abdominal distension, anastomotic leakage, or 30-day readmission.

Conclusion: Early enteral feeding following paediatric gastrointestinal surgery was associated with faster return of bowel function, earlier attainment of full feeds, reduced intravenous fluid requirements, and shorter hospitalization without an apparent increase in major postoperative complications.