Abstract
PurposeWe aimed to evaluate possible positive and negative effects of postoperative use of transanastomotic feeding tube (TAFT) in neonates operated for congenital duodenal obstruction (CDO).MethodsThis is a retrospective study reviewing medical records of neonates operated for CDO during 2003–2020 and comparing postoperative feeding outcomes and complications in patients with and without TAFT. Approval from the hospital’s data protection officer was obtained.ResultsOne hundred patients, 59% girls, were included, and 37% received TAFT. Mean birth weight and gestational age were 2628 (675.1) grams and 36.6 (2.4) weeks, respectively. Furthermore, 45% had no other malformations, and 36% had Down syndrome. Patient demographics were similar for TAFT and not-TAFT patients, except that not-TAFT neonates weighed median 335 g less (p = 0.013). The TAFT group got parenteral nutrition 2 days shorter (p < 0.001) and started enteral feeds 1.5 days earlier (p < 0.001) than the not-TAFT group. Fewer neonates with TAFT got a central venous catheter [65 vs 89%, (p = 0.008)]. In the TAFT group, 67% were breast fed at discharge compared to 49% in the not-TAFT group (p = 0.096).ConclusionNeonates with TAFT had earlier first enteral feed, fewer days with parenteral nutrition and fewer placements of central venous catheters.
Highlights
Congenital duodenal obstruction (CDO) is most commonly caused by duodenal atresia, duodenal web, or obstructive annular pancreas, and affects about 0.5–1.5 in 10 000 newborns [1,2,3]
The 30-day mortality was 3%, all occurred in the not-transanastomotic feeding tube (TAFT) group, and all deaths were caused by serious cardiac disease
The main findings in this study are that the neonates getting a TAFT during CDO surgery received parenteral nutrition (PN) significantly shorter in our institution and started enteral feeds significantly earlier than neonates not getting TAFT
Summary
Congenital duodenal obstruction (CDO) is most commonly caused by duodenal atresia, duodenal web, or obstructive annular pancreas, and affects about 0.5–1.5 in 10 000 newborns [1,2,3]. Standard treatment is surgery within the first few days after birth, creating a duodenoduodenostomy [1, 4]. One of the main challenges after CDO surgery is enteral feeding due to gastric and duodenal retention caused by dysmotility in the dilated stomach and proximal duodenum. Almost all patients need some form of nutritional support the first days after surgery, either as parenteral nutrition (PN) or enteral nutrition through a nasogastric or transanastomotic. Enteral feeding is cost-effective compared to PN. It has been reported that TAFT can reduce health expenses by increasing enteral nutrition and reducing expensive PN [5]. TAFT may reduce time to full enteral feeds, less need for a central venous catheter (CVC), and shorter postoperative length of stay [11].
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