Post-Gastrointestinal Tract Surgery Malnutrition Clinical Trial
Official title:
The Effect of Early Enteral Feeding on Neonatal Outcome After Gastrointestinal Tract Surgery
This study aims to evaluate the effect of early vs late enteral feeding after abdominal surgery on neonatal outcome after surgery, weight gain, length of hospital stay, time to reach full enteral feeding, time to pass first stool, surgical site infections, sepsis and electrolyte disturbances.
There are a many reasons for gastrointestinal (GI) tract surgery and following surgery the
aim is to efficiently establish infants on enteral feeds and wean them off of parenteral
nutrition. Neonates may lose their body resources after surgery due to inadequate nutrient
intake and undergoing long periods of fasting after surgery. Nil peroral (NPO)/nil by mouth
has been the most commonly practiced convention in post-operative period. Misplaced fear of
aspiration, prevent nausea, vomiting and anastomotic complications led to routine
prescription of "NPO." The duration of postoperative fasting is variable but can range from 0
to 5 days depending on the operation. The ramifications of this period of fasting are not
insignificant and may include prolonged length of stay, increased use of parenteral nutrition
(PN), social effects and significant costs to the health system.
Starvation leads to disuse atrophy of villi, decrease disaccharide activity, decreased
intestinal mucosa mass, and loss of DNA of enterocyte. This malfunctioning enterocyte leads
to increase the permeability of intestinal mucosa to antigen and macromolecules. This
starvation-induced gut mucosal injury leads to decrease the production of Vitamin K due to
the absence of normal colonic flora. This also leads to decreased growth factors and bile
acid metabolism. This compounded effect of starved gut and abnormal colonic bacterial
environment leads to colonization of pathological bacteria and might lead to sepsis and
sequelae. In addition, starvation leads to decreased immune cells of intestine gut-associated
lymphoid tissue. This decreased gut immunity leads to increased uptake of toxins and
decreased immune response to foreign antigen. This leads to bacterial translocation
Traditionally after abdominal surgery, presence of bowel sounds or passage of flatus or
stools has been the clinical evidence of restoration of bowel activity and indicators for
starting oral diet. Bowel sounds are poor markers of bowel function as uncoordinated and
antegrade peristalsis can be heard as bowel sounds. Currently, there is no good marker for
return of bowel sounds, and even in the presence of prolonged ileus, the bowel moves .
Cochrane reviews have shown no advantage in keeping patients "nil by mouth" following
gastrointestinal surgery and support early commencement of enteral feeding .
In neonates and infants there are additional issues with delayed feeding including
cholestatic jaundice, sepsis, delayed gut development, and metabolic disease. Early trophic
feeds may improve recovery time by increasing gut blood flow, improving motility and limiting
the impact of starvation on the structure of the gut and its ability to absorb nutrients.
Early introduction of enteral nutrition improves intestinal adaptation, reducing the risk of
intestinal failure-associated liver disease (IFALD).
ESPEN guidelines recommend early initiation of enteral feeding within 24 h after
gastrointestinal surgery, but also state that it needs to be adapted according to the
individual tolerance and type of surgery .
So this study aims to evaluate the effect of early vs late enteral feeding after abdominal
surgery on neonatal outcome after surgery, weight gain, length of hospital stay, time to
reach full enteral feeding, time to pass first stool, surgical site infections, sepsis and
electrolyte disturbances and will include all neonates who undergoing abdominal surgery and
admitted in neonatal intensive care unit in Assiut University Children Hospital for one year.
The study will include 2 groups group A :start enteral feeding within 2 days postoperative
and group B :start enteral feeding after 2 days postoperative according to clinician
discretion based on clinical progress(ranging from 1-5 days after passage of flatus or stool.
;