From
StayCurrentMD
Journal of Pediatric Surgery Article Review: September 2021
With Dr. Mikko Pakarinen & Dr. Julian Goddard & Dr. Iris Lim Butel · hosted by Dr. Rod Gerardo & Dr. Ellen Encisco
Chapter 1 of 3 · Evidence & Research
ERAS feeding trial
Early Feeding vs Traditional Feeding After Neonatal Intestinal Anastomosis
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What the experts said
Although there is evidence that early feeding in adult patients after intestinal surgery is beneficial, the authors didn't find any benefit in neonates
Babies with blood in their stool causing a decrease in hemoglobin has always been a red flag sign for Meckel's diverticulum
The Cincinnati study included all children aged 0-18 years within a 15-mile radius who presented with perianal disease
Only 3% of children presenting with perianal symptoms were diagnosed with Crohn's disease
No children under the age of 1 year with perianal abscess ended up having Crohn's disease within the study period
Higher rates of Crohn's disease were seen in older children, particularly over the age of 10
Many patients in the study had fissures, which are very common in children
Quite a few children with Crohn's disease present with perirectal abscess rather than typical GI symptoms like abdominal pain and diarrhea
In the Chinese trial, the early feeding group started feeds at 2 days compared to 6 days in the traditional feeding group
There was no significant difference between early and traditional feeding groups in length of stay, time to full feeds, postoperative complications, 30-day mortality, or 30-day readmissions
In the early feeding group, patients did not have a decompressing nasogastric tube, suggesting nasogastric decompression is not needed after neonatal intestinal anastomosis
The Utah study created a risk score to predict Meckel's diverticulum in patients presenting with hematochezia
Todd Ponsky suggests using the Meckel's score to go straight to laparoscopy in high-score patients, skipping the Meckel scan, because even with a negative scan he would still suspect Meckel's diverticulum
Under the age of 10, workup for Crohn's disease is not needed in children with perianal symptoms; over age 10, workup should be performed