title: A modern cohort of duodenal obstruction patients: predictors of delayed transition to full enteral nutrition.
abstract: Background. A common site for neonatal intestinal obstruction is the duodenum. Delayed establishment of enteral nutritional autonomy continues to challenge surgeons and, since early institution of nutritional support is critical in postoperative newborns, identification of patients likely to require alternative nutritional support may improve their outcomes. Therefore, we aimed to investigate risk factors leading to delayed establishment of full enteral nutrition in these patients. Methods. 87 patients who were surgically treated for intrinsic duodenal obstructions from 1998 to 2012 were reviewed. Variables were tested as potential risk factors. Median time to full enteral nutrition was estimated using the Kaplan-Meier method. Independent risk factors of delayed transition were identified using the multivariate Cox proportional hazards regression model. Results. Median time to transition to full enteral nutrition was 12 days (interquartile range: 9-17 days). Multivariate Cox analysis identified three significant risk factors for delayed enteral nutrition: gestational age (GA) ≤ 35 weeks (P < .001), congenital heart disease (CHD) (P = .02), and malrotation (P = .03). Conclusions. CHD and Prematurity are most commonly associated with delayed transition to full enteral nutrition. Thus, in these patients, supportive nutrition should strongly be considered pending enteral nutritional autonomy.
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Fegan Building, 3rd Floor, Boston, MA 02215, USA.
authors.forename: Sigrid
authors.identifier: 0000-0001-9741-6130
authors.initials: S
authors.lastname: Bairdain
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Alabama, Birmingham, AL 35233, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Yu
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Fegan Building, 3rd Floor, Boston, MA 02215, USA.
authors.forename: Chueh
authors.identifier: 0000-0002-9240-5376
authors.initials: C
authors.lastname: Lien
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Fegan Building, 3rd Floor, Boston, MA 02215, USA.
authors.forename: Faraz Ali
authors.initials: FA
authors.lastname: Khan
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, MD 21218, USA.
authors.forename: Bhavana
authors.initials: B
authors.lastname: Pathak
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Fegan Building, 3rd Floor, Boston, MA 02215, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Grabowski
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Fegan Building, 3rd Floor, Boston, MA 02215, USA ; Department of Anesthesia, Boston Children's Hospital, Harvard Medical School, Boston, MA 02215, USA.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Pediatric Surgical Associates, Children's Hospitals and Clinics of Minnesota, MN 55404, USA.
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Linden