title: Feeding Post-Pyloromyotomy: A Meta-analysis.
abstract: BACKGROUND
  Postoperative emesis is common after pyloromyotomy. Although postoperative feeding is likely to be an influencing factor, there is no consensus on optimal feeding.
  
  
  OBJECTIVE
  To compare the effect of feeding regimens on clinical outcomes of infants after pyloromyotomy.
  
  
  METHODS
  Cumulative Index to Nursing and Allied Health Literature, The Cochrane Central Register of Controlled Trials, Embase, and Medline.
  
  
  METHODS
  Two reviewers independently assessed studies for inclusion based on a priori inclusion criteria.
  
  
  METHODS
  Data were extracted on methodological quality, general study and intervention characteristics, and clinical outcomes.
  
  
  RESULTS
  Fourteen studies were included. Ad libitum feeding was associated with significantly shorter length of stay (LOS) when compared with structured feeding (mean difference [MD] -4.66; 95% confidence interval [CI], -8.38 to -0.95; P = .01). Although gradual feeding significantly decreased emesis episodes (MD -1.70; 95% CI, -2.17 to -1.23; P < .00001), rapid feeding led to significantly shorter LOS (MD 22.05; 95% CI, 2.18 to 41.93; P = .03). Late feeding resulted in a significant decrease in number of patients with emesis (odds ratio 3.13; 95% CI, 2.26 to 4.35; P < .00001).
  
  
  CONCLUSIONS
  Exclusion of non-English studies, lack of randomized controlled trials, insufficient number of studies to perform publication bias or subgroup analysis for potential predictors of emesis.
  
  
  CONCLUSIONS
  Ad libitum feeding is recommended for patients after pyloromyotomy as it leads to decreased LOS. If physicians still prefer structured feeding, early rapid feeds are recommended as they should lead to a reduced LOS.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; and.
authors.forename: Katrina J
authors.initials: KJ
authors.lastname: Sullivan
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; and.
authors.forename: Emily
authors.initials: E
authors.lastname: Chan
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; and.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Vincent
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; and.
authors.forename: Mariam
authors.initials: M
authors.lastname: Iqbal
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; and.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Wayne
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; and Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada anasr@cheo.on.ca.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Nasr
mesh_terms: D013505:Digestive System Surgical Procedures; D005248:Feeding Methods; D006801:Humans; D007223:Infant; D011182:Postoperative Care / Q000379:methods; D046248:Pyloric Stenosis, Hypertrophic / Q000601:surgery*; D011708:Pylorus / Q000601:surgery*