Early feeding after gastrostomy insertion: a retrospective analysis of a new protocol
Journal of Pediatric Endoscopic Surgery(2022)
Abstract
Enteral feeding following primary gastrostomy insertion in children has traditionally been governed by individual surgeon preference. Lam et al. (J Pediatr Surg 55(5):861–865, 10.1016/j.jpedsurg.2020.01.02, 2020) demonstrated the use of a streamlined post-operative feeding pathway which resulted in shortened length of stay. A modified version of this pathway was introduced in the Royal Hospital for Children, Glasgow in August 2020. Here we sought to evaluate the impact of this pathway on post-operative course. This retrospective analysis evaluated pre-protocol (January 2019–March 2020) and post-protocol (August 2020–May 2021) datasets measuring the outcomes of post-operative time to first feed, time to full feeds, post-operative length of stay as well as dietetic team input. 30 days complications data were also included. 77 patients met inclusion criteria—42 pre-protocol and 35 post-protocol. Children in the post-protocol group were found to have significantly reduced average time to first feed (median 2.5. vs 25.25 h, p < 0.0001) and full feeds (median 13 vs 55.5 h, p < 0.0001) as well as shorter length of stay (median 2 vs 3 days, p < 0.0001). Complications were comparable between the two groups. 19% of patients were seen in the pre-operative period by a dietician in the pre-protocol group vs 83% in the post-protocol group. Early feeding after new gastrostomy insertion reduces time to first and full feeds as well as post-operative length of stay. No significant increase in complications was noted. These findings affirm the role of protocolised early feeding pathways in patients undergoing primary gastrostomy insertion.
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Key words
Gastrostomy,Early feeding,Children
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