A randomized trial to assess advancement of enteral feedings following surgery for hypertrophic pyloric stenosis.
OBJECTIVE
The rate of feeding advancement following surgery for hypertrophic pyloric stenosis (HPS) affects length of stay. We hypothesized that: 1) a relaxed feeding regimen following pyloromyotomy would allow infants to achieve feeding goals more quickly without affecting postoperative emesis, and 2) preoperative metabolic derangements would impair the ability to advance feedings following pyloromyotomy.


METHODS
A prospective, randomized trial compared two postoperative feeding methods. The primary outcome was length of time to tolerate two consecutive goal feeds (GFs). Infants were randomized into the Incremental-arm (N=74), in which infants were gradually advanced on enteral formula, or the Relaxed-arm (N=69), in which infants were allowed to consume up to GF immediately. Preoperative variables, time to GF, preoperative laboratory values, and postoperative emesis were recorded. A p-value less than 0.05 was significant.


RESULTS
Patient demographics, pyloric ultrasound measurements, and episodes of postoperative emesis were similar between groups. Infants in the Relaxed-arm reached GF more quickly than those in the Incremental-arm and had a shorter length of stay (p<0.001). Infants with preoperative serum chloride less than 100mmol/L reached GF more slowly than those with normal labs (p<0.03).


CONCLUSIONS
Following surgery for HPS, surgeons can safely utilize a relaxed, nonstructured feeding regimen, which may allow infants to reach feeding goals more quickly without untoward vomiting.


METHODS
Level 1-therapeutic.
Department of Surgery, Section of Pediatric Surgery, Riley Hospital for Children at Indiana University Health and The Indiana University School of Medicine, Indianapolis, IN. Electronic address: tmarkel@iupui.edu.
Troy A
TA
Markel
Department of Surgery, Section of Pediatric Surgery, Riley Hospital for Children at Indiana University Health and The Indiana University School of Medicine, Indianapolis, IN.
Melissa R
MR
Scott
Department of Surgery, Section of Pediatric Surgery, Riley Hospital for Children at Indiana University Health and The Indiana University School of Medicine, Indianapolis, IN.
Samantha M
SM
Stokes
Department of Surgery, Section of Pediatric Surgery, Riley Hospital for Children at Indiana University Health and The Indiana University School of Medicine, Indianapolis, IN.
Alan P
AP
Ladd
D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D011182:Postoperative Care / Q000379:methods*; D020250:Postoperative Nausea and Vomiting; D011446:Prospective Studies; D046248:Pyloric Stenosis, Hypertrophic / Q000601:surgery / Q000628:therapy*; D011708:Pylorus / Q000601:surgery; D013997:Time Factors
Feeding; Goal feeds; Length of stay; Pyloric stenosis; Pyloromyotomy; Vomiting