Association between early enteral nutrition and length of stay in neonates with congenital bowel obstruction: A retrospective cohort study.

Background: The optimal feeding strategy for postoperative neonatal patients with congenital bowel obstruction is widely debated. This study aims to evaluate perioperative characteristics and postoperative nutrition practices for patients with congenital bowel obstruction. We hypothesized that earlier introduction of enteral nutrition (EN) is associated with shorter hospital stays and increased weight gain velocities.

Methods: We performed a retrospective cohort study on neonatal patients (<30 days old) admitted to a pediatric referral hospital who underwent an operation for bowel obstruction between 2010 and 2020. Demographic information, clinical characteristics, and feeding characteristics were collected. Associations between early EN (EEN), defined as commencement of enteral feeding within 5 days of surgery, and perioperative characteristics were analyzed with SAS 9.4.

Results: Of the 97 neonates with congenital bowel obstruction, 36 patients received EEN. Sex, gestational age, and ethnicity were similar between groups. Patients receiving EEN were more likely to have a diagnosis of malrotation, anorectal malformation, or annular pancreas (P = 0.04). Patients receiving EEN weaned from parenteral nutrition earlier (9 vs 17 days, P = 0.005). Receiving EEN was associated with shorter median hospital stay (16 vs 29 days, P < 0.0001). Weight gain velocities at the 2-month follow-up were greater for patients receiving EEN (8.02 vs 7.00 g/kg/day, P = 0.04) with the difference dissipating at 6 months.

Conclusion: EEN was more likely provided in patients with certain operative diagnoses and was associated with improved outcomes. Creating and implementing an EEN protocol in congenitally obstructed neonates may lead to shorter hospital stays and improved outcomes.