Journal of pediatric surgery · 2026
Trans-anastomotic tube feeding following repair of congenital duodenal obstruction: A 15-year single-centre cohort study.
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Nowak Aleksandra, Rex Dean, Shetty Sandeep, Kulkarni Anay
Аннотация
AIM: To evaluate the association between trans-anastomotic tube (TAT) placement and feeding outcomes following surgical repair of congenital duodenal obstruction (CDO).
METHODS: A retrospective single-centre cohort study of neonates undergoing CDO repair between 2010 and 2024, grouped by intraoperative TAT placement. The main outcome was time to full enteral feeding (≥150 ml/kg/day). Secondary outcomes included time to full oral feeding, postnatal growth, postoperative complications, long line use, parenteral nutrition duration and length of stay with estimated hospital cost. Time-to-event outcomes were analysed using Kaplan-Meier methods and Cox proportional hazards regression adjusted for surgical era, gestational age, birth weight, and associated anomalies. No institutional protocol governed feed advancement or aspirate management in either group during the study period.
RESULTS: 71 infants were included, of whom 25 (35%) received a TAT. Time to full enteral feeding was similar between groups (median 13 vs 12 days; adjusted HR 0.98, 95% CI 0.44-2.21). As a secondary outcome, time to full oral feeding was also similar (median 22 vs 16 days; adjusted HR 0.74, 95% CI 0.31-1.77). Parenteral nutrition duration was similar (median 5 vs 6 days). Growth and complication rates were similar. After adjustment, TAT use was not independently associated with hospital cost. Unadjusted higher costs in the TAT group were driven by longer HDU stay.
CONCLUSION: In this cohort, TAT placement following CDO repair was not associated with earlier enteral feeding, improved postnatal growth, or reduced complications. These findings likely reflect the absence of an optimised nutritional strategy rather than an intrinsic limitation of TAT. A formal alongside nutritional protocol has been developed and is currently undergoing institutional approval prior to prospective evaluation at our centre.
METHODS: A retrospective single-centre cohort study of neonates undergoing CDO repair between 2010 and 2024, grouped by intraoperative TAT placement. The main outcome was time to full enteral feeding (≥150 ml/kg/day). Secondary outcomes included time to full oral feeding, postnatal growth, postoperative complications, long line use, parenteral nutrition duration and length of stay with estimated hospital cost. Time-to-event outcomes were analysed using Kaplan-Meier methods and Cox proportional hazards regression adjusted for surgical era, gestational age, birth weight, and associated anomalies. No institutional protocol governed feed advancement or aspirate management in either group during the study period.
RESULTS: 71 infants were included, of whom 25 (35%) received a TAT. Time to full enteral feeding was similar between groups (median 13 vs 12 days; adjusted HR 0.98, 95% CI 0.44-2.21). As a secondary outcome, time to full oral feeding was also similar (median 22 vs 16 days; adjusted HR 0.74, 95% CI 0.31-1.77). Parenteral nutrition duration was similar (median 5 vs 6 days). Growth and complication rates were similar. After adjustment, TAT use was not independently associated with hospital cost. Unadjusted higher costs in the TAT group were driven by longer HDU stay.
CONCLUSION: In this cohort, TAT placement following CDO repair was not associated with earlier enteral feeding, improved postnatal growth, or reduced complications. These findings likely reflect the absence of an optimised nutritional strategy rather than an intrinsic limitation of TAT. A formal alongside nutritional protocol has been developed and is currently undergoing institutional approval prior to prospective evaluation at our centre.