Pre-operative nutritional status affects enteral feeding in post-operative period among pediatric laparotomy cases

Santosh Kumar Singh, Nitika Agrawal, Kunal Das, Aisha Naaz


Background: Early introduction of enteral feed in postoperative settings, although advocated, is not practiced universally. This study reviews post-operative feeding practices amongst pediatric surgery cases and variables affecting it.

Methods: A retrospective analysis was done for children operated for abdominal conditions during 2013-2015. Data were analyzed for pre-operative variables, operative indications and procedure, post-operative events and feeding practices.

Results: Seventy children underwent laparotomy during study period. Median time of starting enteral nutrition was 3rd post-operative day and full feed attainment was day 6. Severely thin/malnourished children could be started on enteral feed on 3.89+1.76 days while normal nourished children were started on 2.2+0.87 days (p<0.05). Eleven cases noted interruption of feed, regurgitation was the commonest cause. Cases of abdominal Koch’s and cases requiring gut incision showed delay in feed onset.

Conclusions: Post-operative onset of enteral feed and tolerance depends on pre-surgery nourishment status, baseline disease condition and type of surgery.


Abdominal surgery, Feeding, Malnourished, Post-operative nutrition

Full Text:



Goiburu ME, Goiburu MM, Bianco H, Ruiz Díaz J, Alderete F, Palacios MC, et al. The impact of malnutrition on morbidity, mortality and length of hospital stay in trauma patients. Nutr Hosp. 2006;21:604-10.

Rattray M, Roberts S, Marshall A, Desbrow B. A systematic review of feeding practices among post-operative patients: is practice in line with evidence based guideline? J Hum Nutr Diet. 2017.

Khadilkar VV, Khadilkar AV, Choudhary P. IAP growth monitoring guidelines for children from birth to 18 years. Indian Pediatr. 2007;44:187-97.

Khadilkar V, Yadav S, Agrawal KK, et al. Revised IAP growth charts for height, weight and body mass index for 5- to 18- years-old Indian children. Indian Pediatr. 2015; 52: 47-55.

Han-Geurts IJ, Hop WC, Kok NF, Tamboli S, Banerjee M, Cherian A, et al. Randomized clinical trial of the impact of early enteral feeding on post-operative ileus and recovery. Br J Surg. 2007;94:555-61.

Osland E, Yunus RM, Khan S, Memon MA. Early Vs traditional post operative feeding in patients undergoing resectional gastrointestinal surgery. A meta analysis. J Parentr Enter Nutr. 2011;35:473-87.

Caroenkwan K, Matovinovic E. Early versus delayed oral fluid and food for reducing complications after major abdominal gynaecological surgery. Cochrane Database Syst Rev. 2014;12:CD004508.

Murthy TA, Rangappa P, Anil BJ, Jacob I, Rao K. Post-operative practices in abdominal surgery patients in a tertiary referral hospital intensive care unit: A propspective analysis. Ind J Crit Care Med. 2016;20:319-22.

Tohyoon EW, Yonede K, Nishihara K. Semi-solid feed may reduce the risk of aspiration pneumonitis and shorten post-operative length of stay after per cutaneous endoscopic gastrostomy (PEG). Endosc Int Open. 2016;4:E1247-51.

Radman M, Mack R, Barnoya J. The effect of pre-operative nutritional status on post-operative outcomes in children undergoing surgery for congenital heart defects in San Francisco (UCSF) and Guatemala city (UNICAR). J Thorac Cardiovasc Surg. 2014;147:442-50.