A modern cohort of duodenal obstruction patients: predictors of delayed transition to full enteral nutrition

Abstract

Background. A common site for neonatal intestinal obstruction is the duodenum. Delayed establishment of enteral nutritional autonomy continues to challenge surgeons and, since early institution of nutritional support is critical in postoperative newborns, identification of patients likely to require alternative nutritional support may improve their outcomes. Therefore, we aimed to investigate risk factors leading to delayed establishment of full enteral nutrition in these patients. Methods. 87 patients who were surgically treated for intrinsic duodenal obstructions from 1998 to 2012 were reviewed. Variables were tested as potential risk factors. Median time to full enteral nutrition was estimated using the Kaplan-Meier method. Independent risk factors of delayed transition were identified using the multivariate Cox proportional hazards regression model. Results. Median time to transition to full enteral nutrition was 12 days (interquartile range: 9-17 days). Multivariate Cox analysis identified three significant risk factors for delayed enteral nutrition: gestational age (GA) ≤ 35 weeks (P < .001), congenital heart disease (CHD) (P = .02), and malrotation (P = .03). Conclusions. CHD and Prematurity are most commonly associated with delayed transition to full enteral nutrition. Thus, in these patients, supportive nutrition should strongly be considered pending enteral nutritional autonomy.

Figure 1

(a) Kaplan-Meier curves illustrating the progression to 100% enteral nutrition (100% EN) in patients without congenital heart disease (CHD). The importance of low gestational age (GA) is that if a patient was GA > 35 weeks (n = 30) then the median time to progression was 10 days (IQR: 8–12 days). However, if the GA ≤ 35 weeks (n = 9) then the median time to progression was 16 days (IQR: 11–20 days) (P = .003, log-rank test = 9.12). (b) Kaplan-Meier curves illustrating the progression to 100% enteral nutrition (EN) in patients with congenital heart disease (CHD) and illustrates the synergistic effect of CHD on prematurity. For those patients with GA > 35 weeks (n = 27) and CHD, the median time to progression was 11 days (IQR: 8–14 days). For those patients with GA ≤ 35 weeks (n = 20) and CHD, their median time to progression was 23 days (IQR: 15–30 days) (P < .001, log-rank test = 16.21). Both prematurity and the presence of CHD translated into a much longer delay in progression to 100% EN.