Application of enhanced recovery after surgeryplus transnasal placement of jejunal feeding tube for intestinal malrotation in neonates

Abstract

Objective To evaluate the safety and efficacy of enchanced recovery plus transnasal placement of jejunal feeding tube for intestinal malrotation in neonates. Methods A prospective study was conducted for assessing the safety and efficacy of enhanced recovery after surgery (ERAS) plus transnasal placement of jejunal feeding tube for intestinal malrotation. A total of 51 surgical neonates aged from 1 day to 28 days with intestinal malrotation from January 2015 to March 2018 were recruited and divided into ERAS group (ERAS plus transnasal placement of jejunal feeding tube, n=31) and control group (n=20) according to the parental willingness on admission. The parameters of intraoperative blood loss, operative duration, preoperative hospital stay, time to initial defecation, time to initial enteral nutrition, time to total enteral nutrition time, postoperative stress and complications were compared. Postoperative recovery was tracked for 6 months. Results Significant inter-group differences existed in preoperative hospital stay [(1.78±0.33) vs. (2.28±0.74) days], operative duration [(139.16±7.03) vs. (74.30±5.92)min], time to first defecation [(1.80±0.33)vs.(2.25±0.54)days], time to initial enteral nutrition [(1.32±0.31) vs. (4.42±0.82) days] and time to total enteral nutriton [(7.55±0.66) vs. (8.40±0.75) days] (all P<0.05). There were also inter-group statistical differences (P<0.05) in stress parameters at 24h post-operation including c-reactive protein (CRP) [(9.29±1.81) vs.(20.45±4.31) mg/L], interleukin-6 [(2.76±0.21) vs. (7.10±1.02) pg/L] and cortisol [(86.75±32.77) vs.(156.75±35.59) nmol/L]. However, the difference of intraoperative blood loss was not statistically significant between two groups [(18.77±3.57) vs. (18.90±3.48) ml]. As for postoperative complications, there was no recurrence of volvulus in neither groups and no incision infection in ERAS group. However, two incision infections occurred in control group. The inter-group rates of respiratory tract infection and diarrhea were not statistically significant [9.6%(3/31) vs. 15.0%(3/20), 6.4%(2/31) vs. 10.0%(2/20)]. No postoperative re-hospitalization occurred during a 6-month follow-up period. Conclusions ERAS plus transnasal placement of jejunal feeding tube are both safe and feasible for intestinal malrotation in neonates. It may reduce stress injuries and enhance early recovery after surgery. Key words: Enteral Nutrition; Jejunum; Malrotation of intestine; Enhanced recovery after surgery