J. Karpelowsky1,2, D. T. McDowell1,2, C. Langusch1,2 1Division of Child and Adolescent Health, Sydney Medical School, University of Sydney, Department of Paediatric Surgery, Sydney, New South Wales, Australia 2The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
Introduction: Infantile hypertrophic pyloric stenosis (IHPS) is a common condition affecting young infants and requires operative treatment (pyloromyotomy). Vomiting is common following pyloromyotomy, and traditionally these infants have been kept fasting for a period of 4-24hours following surgery before feeds are gradually reintroduced. Our study sought to prospectively investigate whether early ad libitum feeds decreased the time to full feeds compared to delayed reintroduction of feeds.
Methods: The inclusion criteria for this randomised controlled trial were all patients undergoing pyloromyotomy. Exclusion criteria were patients with incomplete pyloromyotomy or in whom intra-operative perforation occurred. Pre-operatively, patients were randomised to either the immediate or delayed feeding groups. Primary outcome measure was time to full feeds. Secondary outcome measures post-operative vomiting and time to discharge.
Results: There were 127 patients recruited with 120 in the final analysis; 59 and 61 patients in the early and delayed-feeding groups respectively. The groups were equivalent in terms of sex, age at operation and type of surgery (laparoscopic or open). The mean time to full feeds in the immediate feeding group was 16.2hrs (SD 11.5hrs) and in the delayed feeding group was 19.4hrs (SD 15.2hrs) – this was not statistically significant (p=0.394). There was no significant difference post-operative vomiting (0.341) or time to discharge between the two groups (p=0.587).
Conclusion: These results demonstrate that it is safe to feed infants early after pyloromyotomy. The time to discharge however is not reduced by early feeding post-operatively.