European Journal of Molecular & Clinical Medicine

Abstract

Aim: the aim of this study to evaluate the predictive factors for time to full enteral feeding after pyloromyotomy for infantile hypertrophic pyloric stenosis.
Materials and methods: This is a retrospective study conducted in the Department of Paediatrics surgery Patna Medical College and Hospital, Patna, Bihar, India and Sushrut Child Surgery Centre, Patna, Bihar from October 2016 to January 2020. All children underwent pyloromyotomy were include in this study. Inclusion criteria were diagnosis of isolated IHPS and isolated pyloromyotomy operation. The diagnosis of IHPS was based on clinical symptoms and ultrasound findings. Parameters in demographics and in the preoperative and postoperative period were evaluated against TFEF (hours) using linear regression models.
Results: Total 200children’s were included in this study. Out of 200, 160 (80%) boys, with a mean corrected age of 39±15 days, a mean weight of 3897 g, 31 (15.5%) of which were premature, and 17 (8.5%) of which had a severe underlying disease. Median duration of symptoms was 4.2 days (IQR: 8); 151 patients (75.5%) experienced weight loss; and increased bilirubin was seen in 25 patients (12.5%). Mean TFEF was 48±42 hours and mean length of postoperative hospital stay was 67±51 hours. The majority of children (89.5%) were fed according to a feeding schedule. No child required intravenous nutrition. There were 11 children (5.5%) presented with postoperative complications, of which 7 required reoperation. In the univariate analysis, age, weight, severe underlying disease increased bilirubin level, and duration of symptoms were found to affect TFEF. In the multivariate analysis, only age (B: −0.63 (−1.15 to −0.21), p=0.005). and severe underlying disease (B:26.64(3.41 to 51.52),p=0.021)remained as variables significantly affecting TFEF. Hence, for every day of age, the time to fully fed decreased with 0.7 hour, and the presence of an underlying disease increased the time to fully fed with over 1 day. TFEF did not seem to be affected by prematurity, preoperative weight loss, symptom duration, preoperative acid/base balance or electrolyte values, surgical method, or method of postoperative feeding (table 3 and 4).
Conclusion: we conclude that the time to full enteral feeding decreased with higher age and increased in children with a severe underlying disease.