Pediatrics · 2015
Feeding Post-Pyloromyotomy: A Meta-analysis.
СтатьяМетаанализОбзорНазвание и аннотация: Перевод пока не подготовлен
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Sullivan Katrina J, Chan Emily, Vincent Jennifer, Iqbal Mariam, Wayne Carolyn, Nasr Ahmed, Canadian Association of Paediatric Surgeons Evidence-Based Resource
Аннотация
CONTEXT: 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.
DATA SOURCES: Cumulative Index to Nursing and Allied Health Literature, The Cochrane Central Register of Controlled Trials, Embase, and Medline.
STUDY SELECTION: Two reviewers independently assessed studies for inclusion based on a priori inclusion criteria.
DATA EXTRACTION: 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).
LIMITATIONS: 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.
OBJECTIVE: To compare the effect of feeding regimens on clinical outcomes of infants after pyloromyotomy.
DATA SOURCES: Cumulative Index to Nursing and Allied Health Literature, The Cochrane Central Register of Controlled Trials, Embase, and Medline.
STUDY SELECTION: Two reviewers independently assessed studies for inclusion based on a priori inclusion criteria.
DATA EXTRACTION: 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).
LIMITATIONS: 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.