title: Surgical fasting guidelines in children: Are we putting them into practice?
abstract: BACKGROUND
  Patients are traditionally kept fasting (NPO) from midnight prior to surgery, to prevent aspiration during anesthesia. NPO time is continued postoperatively, out of concern for ileus. Prolonged periods of NPO place the pediatric population at risk for under-nutrition. Published guidelines for preoperative NPO times have been shown to be safe. The aim of this study was to investigate current pre- and postoperative feeding practices of children at a pediatric tertiary care hospital.
  
  
  METHODS
  Medical charts were used to extract data prospectively from 53 patients undergoing general, neurosurgical, or urological procedures. Date and time of NPO periods were recorded as well as the physician's postoperative diet orders and diet progression. Surgical procedures were classified as complex or noncomplex by the surgeons. Data were summarized and compared to published recommendations.
  
  
  RESULTS
  Preoperative NPO times were greater than recommended in 70% of patients studied (n=37). Median time spent NPO preoperatively was not significantly different between complex (11.5h) and noncomplex groups (10.8h). Postoperative NPO time was significantly greater for complex procedures than for noncomplex. Most patients received some postoperative NPO time, even when it was not included in the physician diet order.
  
  
  CONCLUSIONS
  Observed preoperative NPO time exceeded current recommendations in this study.
authors.affiliation: Nutrition Services, Alberta Health Services. Electronic address: kim.brunetwood@albertahealthservices.ca.
authors.forename: Kim
authors.initials: K
authors.lastname: Brunet-Wood
authors.affiliation: Department of Agricultural, Life, and Environmental Sciences, University of Alberta. Electronic address: Mariska.simons@albertahealthservices.ca.
authors.forename: Mariska
authors.initials: M
authors.lastname: Simons
authors.affiliation: Department of Agricultural, Life, and Environmental Sciences, University of Alberta. Electronic address: Amanda.evasiuk@albertahealthservices.ca.
authors.forename: Amanda
authors.initials: A
authors.lastname: Evasiuk
authors.affiliation: Department of Agricultural, Life, and Environmental Sciences, University of Alberta. Electronic address: vmazurak@ualberta.ca.
authors.forename: Vera
authors.initials: V
authors.lastname: Mazurak
authors.affiliation: Department of Pediatrics, University of Alberta. Electronic address: bryan.dicken@albertahealthservices.ca.
authors.forename: Bryan
authors.initials: B
authors.lastname: Dicken
authors.affiliation: Nutrition Services, Alberta Health Services. Electronic address: denise.ridley@albertahealthservices.ca.
authors.forename: Denise
authors.initials: D
authors.lastname: Ridley
authors.affiliation: Nutrition Services, Alberta Health Services; Department of Agricultural, Life, and Environmental Sciences, University of Alberta; Department of Pediatrics, University of Alberta. Electronic address: bodil.larsen@albertahealthservices.ca.
authors.forename: Bodil
authors.initials: B
authors.lastname: Larsen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005215:Fasting; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011300:Preoperative Care; D011446:Prospective Studies; D013514:Surgical Procedures, Operative
keywords: Feeding practice; NPO; Pediatric; Postoperative; Preoperative; Surgery