Early versus Delayed Enteral Nutrition after Gastrointestinal Anastomosis in Children: A Systematic Review and Meta-Analysis

Abstract

Abstract Background Elective intestinal anastomosis is a frequently used surgical procedure in pediatric surgery. This option is used to restore intestinal continuity (ileostomy or colostomy closure), resolve an inflammatory disease or functional or anatomic congenital malformation. It is a common practice to avoid oral feeding in children after intestinal anastomosis surgery, traditionally from 3-5 days. Recently, interest has increased in the concept of early enteral nutrition (EEN) in abdominal surgery in adults, but it needs further research in children. Aim of the Work The aim of this study is to determine whether early enteral nutrition following elective gastrointestinal anastomosis surgery in children leads to improved patient outcome measures and to assess whether this practice increases the risk of postoperative complications, according to literature published in the period from 2010- 2020 Patients and Methods We searched PubMed, Cochrane, Embase, Google scholar, Egyptian Knowledge Bank including Science Direct, Scopus and Web of Science. Data from 2010 – 2020 were obtained using the following Medical Subject Headings (MeSH) terms. For the early aspect of nutrition, we used the MeSH terms ‘‘early’’ or ‘‘enhanced recovery’’ and ‘‘enteral nutrition’’ or ‘‘feeding’’. For the surgical background, we used the MeSH terms ‘‘gastrointestinal’’ or ‘‘bowel/intestinal’’ or ‘‘colorectal’’ and ‘‘surgery’’ or ‘‘anastomosis’’ or ‘‘resection,’’ while for the population we used the terms ‘‘child’’ or ‘‘pediatric’’ or ‘‘infant’’. Multiple outcomes were used. The softwares Review Manager (RevMan 5.3, The Cochrane Collaboration) and STATA (Stata Corp. 2007) were used to analyse the data and formulate the results. Results Seven RCT studies met the inclusion criteria, comprising 278 cases with EEF and 323 cases with DEF. Enteral feeding started significantly earlier in the EEF group compared to the DEF group (MD = -69.43; 95% CI -72.20 to -66.65; p < 0.0001). The EEF group had an earlier time to first bowel movement (MD -18.18; 95% CI -27.04 to -9.32; p < 0.0001), an earlier time to full diet intake (MD -103.50; 95% CI -126.63 to -80.37; p < 0.00001) and a shorter length of hospital stay (MD -3.57; 95% CI -4.4 to -2.74; p < 0.00001). There was no significant difference in incidence of nausea and vomiting (OR = 1.36; 95% CI 0.56, 3.30; p = 0.5), abdominal distension (OR = 1.68; 95% CI 0.80, 3.53; p = 0.17) or anastomotic dehiscence (OR = 0.58; 95% CI 0.19, 1.75; p = 0.34) between groups. There was significant difference between groups in surgical site infection (OR = 0.27; 95% CI 0.13, 0.57; p = 0.0005) and fever (OR = 0.32; 95% CI 0.16, 0.61; p = 0.0007) in favour of EEN. Conclusion When early enteral nutrition was compared to traditional delayed feeding, results showed that EEN is safe and effective in pediatric patients undergoing elective intestinal anastomosis.