title: A liberalized fasting guideline for formula-fed infants does not increase average gastric fluid volume before elective surgery.
abstract: Recommended preoperative fasting intervals for infant formula vary from 4 to 8 h. We conducted a prospective, randomized, observer-blinded trial of 97 ASA physical status I and II infants scheduled for elective surgery to determine whether average gastric fluid volume (GFV) recovered from infants formula-fasted for 4 h (liberalized fast, Group L) differed from that recovered from infants allowed clear liquids up until 2 h, but fasted 8 h for formula and solids (traditional fast, Group T). In Group L, 31 of 39 subjects followed protocol and ingested formula 4-6 h before surgery. In Group T, 36 of 58 subjects followed protocol, taking clear liquids 2-5 h before the induction of anesthesia. Thirty subjects had prolonged fasts and were included only in a secondary intent-to-treat analysis. Respective mean age (5.7 +/- 2.3 versus 6.4 +/- 2.4 mo; range, 0.7-10.5 mo), weight (7.5 +/- 1.8 versus 7.5 +/- 1.1 kg), and volume of last feed (4.9 +/- 2.2 versus 4.0 +/- 2.3 oz.) did not vary between Groups L and T. GFV (L: 0.19 +/- 0.38 versus T: 0.16 +/- 0.30 mL/kg) and gastric fluid pH (L: 2.5 +/- 0.5 versus T: 2.9 +/- 1.3) did not vary. For all subjects, GFV (mL/kg) increased with age (Spearman correlation coefficient = +0.23, P = 0.03). Infant irritability and hunger and parent satisfaction were similar between groups. We conclude that average GFV after either a 4- to 6-h fast for infant formula or 2-h fast after clear liquids is small and not significantly different between groups. On the basis of these findings, clinicians may consider liberalizing formula feedings to 4 h before surgery in selected infants.
  
  
  CONCLUSIONS
  Healthy infants aged < or =10.5 mo may drink formula up to 4 h before surgery without increasing gastric fluid volume compared with infants allowed clear liquids up to 2 h and formula 8 h before surgery.
authors.affiliation: Departments of *Anesthesiology and Critical Care Medicine and †Pediatrics, Division of Biostatistics and Epidemiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: William J
authors.initials: WJ
authors.lastname: Greeley
authors.forename: Scott D
authors.initials: SD
authors.lastname: Cook-Sather
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Harris
authors.forename: Rosetta
authors.initials: R
authors.lastname: Chiavacci
authors.forename: Paul R
authors.initials: PR
authors.lastname: Gallagher
authors.forename: Mark S
authors.initials: MS
authors.lastname: Schreiner
mesh_terms: D000339:Affect; D000375:Aging / Q000502:physiology; D000758:Anesthesia; D001826:Body Fluids / Q000502:physiology; D005215:Fasting / Q000009:adverse effects; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D006815:Hunger / Q000502:physiology; D007223:Infant; D007225:Infant Food; D007231:Infant, Newborn; D008297:Male; D010290:Parents; D011015:Pneumonia, Aspiration / Q000517:prevention & control*; D011300:Preoperative Care / Q000592:standards*; D013270:Stomach / Q000502:physiology*