Comparison of Tolerance and Complication Rates between Early and Delayed Feeding after PEG Placement in Children.

BACKGROUND Enteral nutrition is commonly initiated 24-hours after percutaneous endoscopic gastrostomy (PEG) in children. Adult studies report safe refeeding within 1-6 hours of PEG and these findings have been cautiously applied to children. However, comparative studies assessing early vs next-day refeeding in children are currently lacking. This study evaluates feeding tolerance and complications following early vs. next-day refeeding in children. METHODS This is a single-center, pre-post study. In June 2015 our clinical practice changed to begin refeeding within 6-hours of PEG. Children receiving early refeeding from December 2015 to August 2017 were included. A retrospective cohort from February 2013 to April 2015 was used for comparison. RESULTS 46 children received early refeeding after PEG and 37 received next-day refeeding. Gender distribution was similar in the two groups. Early refeeding patients were slightly older (3.5 vs. 2.2 years) and heavier (15.5 kg vs. 11.5 kg) at PEG placement compared to next-day refeeding patients. Early Refeeding patients experienced greater post-procedural nausea and/or vomiting (19% vs 8%, p < 0.001) and leakage, irritation, and infection around the stoma (19% vs 0.0%, p < 0.001). Compared to Early Refeeders, Next-Day Refeeding patients experienced higher occurrence of fever (35% vs 13%, p = 0.021), longer nutritional disruption (24.6 vs 3.7 hours, p < 0.001) and longer length of stay (51 vs. 27 hours; p < 0.001). One Next-Day-Refeeding patient experienced peritonitis. One Early Refeeding patient experienced cellulitis requiring hospitalization and a second experienced gastrostomy tube migration into the peritoneal cavity requiring removal. CONCLUSION Early Refeeders experienced higher rates of post-procedural nausea or vomiting and irritation, leakage or infection around the stoma; but experienced lower rates of post-operative fever. Early refeeding resulted in reduced nutritional interruption and hospital length of stay.