Postoperative feeding in neonatal duodenal obstruction

Abstract

Background: Findings from manometry studies and contrast imaging reveal functioning gastric physiology in newborns with duodenal atresia and stenosis. Stomach reservoir function should therefore be valuable in aiding the postoperative phase of gastric feeding. The aim of this study was therefore to compare the feasibility of initiating oral or large volume(s) gavage feeds vs small volume bolus feeds following operation for congenital duodenal anomalies.

Methods: Single-center electronic medical records of all babies with duodenal atresia and stenosis admitted to a university surgical center during January 1997-September 2021 were analyzed. A fast-fed group (FF) included newborns fed with oral or gavage feeds advanced at a rate of at least 2.5 ml/kg and then progressed more than once a day vs slow-fed group (SF) fed with gavage feeds at incremental rate less than 2.5 ml/kg/day for each time period of oral tolerance or by drip feeds. Total feed volume was limited to 120-150 ml/kg/day in the respective study cohort populations.

Results: Fifty-one eligible patients were recruited in the study - twenty-six in FF group and twenty-five in SF group. Statistically significant differences were observed in the (i) date of first oral feeds (POD 7.7 ± 3.2 vs 16.1 ± 7.7: p < 0.001), and (ii) first full feeds (POD 12.5 ± 5.3 vs 18.8 ± 9.7: p < 0.01) in FF vs SF study groups.

Conclusion: Initial feeding schedules with oral or incremental gavage-fed rates of at least 2.5 ml/kg in stepwise increments and multi-steps per day is wholly feasible in the postoperative feeding regimens of neonates with congenital duodenal disorders. Significant health benefits are thus achievable in these infants allowing an earlier time to acquiring full enteral feeding and their hospital discharge.

Keywords: Duodenal atresia; Duodenal stenosis; Gastric reservoir; Gavage feeding; Oral feeds.

Fig. 1

Shows average volume of gastric content (mls) in each postoperative date (days) in patient study groups of fast and slow attempted feeds

Fig. 2

Shows the number of patients in each postoperative date (days) who have commenced type of feeding schedule categorized into Fast and Slow feeds

Fig. 3

Shows the correlation of GA vs OG content 1 day before feed by feeding type: the overall Correlation (r = 0.188), p-value = 0.217

Fig. 4

Shows the correlation of GA vs OG content 1 day before feed per BW by feeding type: the overall Correlation (r = 0.031), p-value = 0.842

Fig. 5

Shows the insignificant correlation (r = 0.088, p = 0.539) between the volume of gastric content one day before starting feed and birth weight