Early Enteral Nutrition in Neonates Following Abdominal Surgery

• Main Authors: G. Raghavendra Prasad, J. V. Subba Rao, Amtul Aziz, T. M. Rashmi, Saniya Ahmed
• Format: Article
• Language: English
• Published: EL-Med-Pub 2018-04-01
• Series: Journal of Neonatal Surgery
• Subjects: Early enteral nutrition; Endogenous endotoxemia; Nil per oral
• Online Access: https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/384

Introduction: Nil per oral (NPO)/nil by mouth has been the most commonly practiced convention in post-operative period. Misplaced fear of aspiration led to routine prescription of “NPO.” Starvation leads to atrophy of the gut mucosa leading to decreased barrier effect of gut mucosa. This starvation-induced gut mucosal injury increases septic complications and mortality. The study aims at establishing the feasibility and effect of early enteral nutrition (EEN) in neonates following abdominal surgeries. Materials and Methods: A total of 260 cases formed the cohort of prospective cohort study, 79 in EEN - Group “A” and 181 in NPO - Group “B.” Effect of EEN was evaluated with regard to outcome, hospital stay, surgical site infections (SSI), stress markers such as C-reactive protein (CRP), procalcitonin, tumor necrosis factor alpha (TNF α), and neonatal-predisposition, insult/injury, response, organ failure (Neo-PIRO) scores, intra-abdominal pressure (IAP) grade, tolerance of feeds, and time to first stool. Chi-square was the statistical method used. Epi info version 7 was the software used. Results: Group B had higher mortality (20.09%) than Group A (P < 0.05). 33.7 in Group B developed SSI, of which 90% were deep and intracavitary (P < 0.05). Hospital stay was less in Group A (P < 0.05). CRP and Neo-PIRO scores were less in Group A compared to Group B (P < 0.05). TNF-α expression and IAP scores were not statistically significant (P > 0.05). Procalcitonin levels were higher in Group B. Feeds were better tolerated in Group A. First stool appeared earlier in Group A than B. There was no difference in anastomotic leak in both the groups. Conclusion: EEN in neonates following abdominal surgeries is feasible, well tolerated reduces the hospital stay and mortality, and reduces SSIs, and early gut motility could be established.