| PurposeCongenital duodenal obstruction is a common digestive system malformation in newborns.If left untreated,electrolyte disorders,protein malnutrition,and even serious complications such as intestinal necrosis and perforation can occur,seriously affecting growth and development.After diagnosis,early surgery is necessary.Traditionally,long-term fasting and total parental nutrition were advised after duodenal obstruction surgery until the anastomotic site had healed and feeding was allowed.However,long-term fasting leads to intestinal mucosal atrophy,decreased expression of intestinal enzymes,changes in intestinal motility,and further feeding intolerance,even affecting the weight gain of the patient.Long-term fasting also prolongs hospitalization and increases hospital costs.With the continuing understanding of digestive function and the rapid development of enhanced recovery after surgery,early enteral nutrition after duodenal anastomosis in newborns is becoming increasingly reported as safe,but the timing of feeding,feeding methods,efficacy,and clinical application remain controversial and lack evidence-based medical evidence.This study aims to compare the perioperative indicators of early enteral nutrition and conventional feeding after minimally invasive surgery for congenital duodenal obstruction in newborns through a single-center prospective randomized controlled study,evaluate the safety and clinical value of early enteral nutrition,and propose a new plan for early enteral nutrition after minimally invasive surgery for congenital duodenal obstruction in newborns.MethodsA single-center prospective randomized controlled trial will be conducted from January 2021 to December 2022 in the Neonatal Surgery Department of Guangdong Women and Child Health Hospital in China.Newborns diagnosed with duodenal obstruction and undergoing minimally invasive surgery were divided into two groups using envelope randomization: the early enteral nutrition group(EEN group)and the conventional feeding group.The primary outcome measures included the time of first feeding after surgery,time to reach full feeding,postoperative hospital stay,and hospital costs;secondary outcome measures included the occurrence of relevant complications,reoperation rate,and readmission rate.The differences in weight,inflammation indicators(white blood cell count,platelet count,C-reactive protein),and nutritional indicators(serum albumin,hemoglobin)were compared between the two groups before surgery and on the 5th day after surgery.SPSS 26.0 software was used for data analysis,measurement data were expressed as mean ± standard deviation,and comparison between the two groups was conducted by t test or Mann-Whitney U test.Counting data were represented by actual frequency,and chi-square test was used for comparison between the two groups.P < 0.05 was considered statistically significant.Results1.A total of 77 pediatric patients with confirmed duodenal obstruction underwent minimally invasive surgery,of which 5 had severe comorbidities and one had intraoperative placement of abdominal drainage.One patient experienced long-term intolerance to postoperative feeding,and 7 cases were excluded.Ultimately,70 cases were included,with 37 in the early enteral nutrition(EEN)group and 33 in the conventional feeding group.Among them,9 cases had congenital duodenal diaphragm,13 had congenital duodenal atresia,5 had congenital duodenal stenosis,16 had annular pancreas,25 had congenital intestinal malrotation,and 2 had a combination of the above two causes.2.There were no statistically significant differences in age of admission,birth weight,birth mode,age of operation,duration of operation between the two groups before surgery(P > 0.05).3.The first postoperative feeding time was(1.35 ± 0.05)d in the EEN group and(6.00 ± 2.99)d in the conventional feeding group,and the difference between the two groups was statistically significant(P < 0.05).Postoperative feeding time was(8.05 ± 2.98)d in EEN group and(11.18 ± 4.29)d in conventional feeding group,and the difference between the two groups was statistically significant(P < 0.05).Postoperative hospital stay of the EEN group and the conventional feeding group were(8.78 ± 3.05)d and(11.82 ± 4.39)d,and the difference between the two groups was statistically significant(P < 0.05).The hospitalization expense of EEN group was(45052.73 ± 9601.39)yuan,and that of conventional feeding group was(46498.12 ± 11024.87)yuan.There was no significant difference between the two groups(P > 0.05).4.There were no significant differences in weight change(5th day postoperatively-preoperatively),incidence of related complications,rate of re-hospitalization and rate of re-operation among groups(P > 0.05).5.32 cases had missing blood indicators(21 in the EEN group and 11 in the conventional feeding group).For the cases with complete blood indicators,there were16 cases in the EEN group and 22 in the conventional feeding group,and there was no significant difference(P > 0.05)in the changes of white blood cells,platelets,C-reactive protein,hemoglobin,and serum albumin between the two groups(5th day postoperatively-preoperatively).ConclusionsEarly enteral nutrition after minimally invasive surgery for duodenal obstruction in neonates is safe and does not increase the incidence of feeding intolerance,surgery-related complications,reoperation rate,or readmission rate compared to conventional feeding methods.It promotes rapid postoperative recovery and shortens hospital stay,making it clinically valuable and worthy of further promotion. |
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