A total of 51 patients were included in the study – (FF: n = 26) fast-fed group (FF) and (SF: n = 25) slow-fed group (SF). No statistical differences were observed in the demographic data, surgical pathology or associated disorders between the study patient groups - Table 1.
Table 1
Variable
|
Total
(n = 51)
|
fast feed
(n = 26)
|
slow feed
(n = 25)
|
p-value
|
Gender, n (%)
|
|
|
|
|
Male
|
28(54.9)
|
15(57.7)
|
13(52.0)
|
0.683
|
Female
|
23(45.1)
|
11(42.3)
|
12(48.0)
|
|
Birth weight (gm), mean ± SD
|
2423 ± 524
|
2554 ± 422
|
2287 ± 590
|
0.068
|
GA (weeks), mean ± SD n = 43
|
36.5 ± 1.8
|
36.8 ± 1.6
|
36.3 ± 2.1
|
0.442
|
Term, n (%) n = 6
|
6(11.8)
|
5(19.2)
|
1(4.0)
|
0.191
|
Ward of feed, n (%)
|
|
|
|
|
Ped
|
35(68.6)
|
16(61.5)
|
19(76.0)
|
0.266
|
Ped Sx
|
16(31.4)
|
10(38.5)
|
6(24.0)
|
|
Age at surgery (day), median (IQR)
|
4(2, 8)
|
5(3, 8)
|
3(2, 5)
|
0.117
|
Atresia type, n (%)
|
|
|
|
|
stenosis
|
14(27.5)
|
7(26.9)
|
7(28.0)
|
0.512
|
web
|
15(29.4)
|
10(38.5)
|
5(20.0)
|
|
cord
|
5(9.8)
|
2(7.7)
|
3(12.0)
|
|
gap
|
17(33.3)
|
7(26.9)
|
10(40.0)
|
|
Annular pancreas, n (%)
|
|
|
|
|
No
|
35(68.6)
|
20(76.9)
|
15(60.0)
|
0.193
|
Yes
|
16(31.4)
|
6(23.1)
|
10(40.0)
|
|
Down syndrome, n (%)
|
|
|
|
|
No
|
30(58.8)
|
14(53.8)
|
16(64.0)
|
0.461
|
Yes
|
21(41.2)
|
12(46.2)
|
9(36.0)
|
|
Heart disease, n (%)
|
|
|
|
|
No
|
31(60.8)
|
17(65.4)
|
14(56.0)
|
0.493
|
Yes
|
20(39.2)
|
9(34.6)
|
11(44.0)
|
|
Other, n (%)
|
|
|
|
|
No
|
31(60.8)
|
17(65.4)
|
14(56.0)
|
0.493
|
Yes
|
20(39.2)
|
9(34.6)
|
11(44.0)
|
|
Medical problem, n (%)
|
|
|
|
|
No
|
28(54.9)
|
16(61.5)
|
12(48.0)
|
0.331
|
Yes
|
23(45.1)
|
10(38.5)
|
13(52.0)
|
|
Complicated surgery, n (%)
|
|
|
|
|
No
|
37(72.5)
|
17(65.4)
|
20(80.0)
|
0.242
|
Yes
|
14(27.5)
|
9(34.6)
|
5(20.0)
|
|
** Fisher's exact test > Term, Atresia type |
Chi-square test > Gender, Ward of feed, Annular pancreas, Down syndrome, Heart disease, Other, Medical problem, Complicated surgery |
Wilcoxon Mann-Whitney test (non-normal) > Age at surgery |
Student t-test (normal) > Birth weight (gm), GA (weeks) |
There were no differences in gestational age of the patient study groups (FF vs SF) GA (mean ± SD: 36.8 ± 1.6, 36.3 ± 2.1, p = 0.442) or BW (range: 1,510-3,500 gms, mean ± SD: 2,554 ± 422, 2,287 ± 590, p = 0.068). Pediatricians were responsible for the varied feeding management in FF 61.5% and SF 76% (p = 0.266). Median age(s) (IQR) at operation were 5 (3,8) and 3 (2,5) days; p = 0.117. Associated disorders considered likely to impact feeding included Down’s syndrome and congenital heart disease, feeding-associated medical and surgical problems were all not different between patient study groups (p = 0.461, 0.493, 0.331 and 0.242 respectively). Gastric function inferred from the graph is plotted for average gastric content on each postoperative day (Fig. 1) and the number of patients who had first fed on each consecutive postoperative date (Fig. 2). Overall the patient study cohort groups and gastric function were noted to be similar.
Table 2 shows that gastric content one day before starting feeding was indifferent between study groups (mean ± SD: 22.4 ± 15.9, 26.4 ± 16.7, p = 0.391) even when calculated per kilogram of BW (mean ± SD: 8.8 ± 6.3, 11.9 ± 7.6, p = 0.125). Correlating with GA as shown in Fig. 3 and Fig. 4, the correlation (r) of all patients with regard the gastric content one day before starting feeding was 0.188 (p = 0.217) and that (r) of those calculated per kilogram of BW was 0.031 (p = 0.842) indicating that the absolute volumes of gastric content before starting first feeds was less well correlated to the gestational maturity (GA) of the newborns and could therefore not be used as feeding predictor.
Table 2
Variable
|
Total
|
Fast feed
|
Slow feed
|
P-value
|
OG content at 1 day before starting OG feed, mean ± SD
|
24.4 ± 16.3
|
22.4 ± 15.9
|
26.4 ± 16.7
|
0.391
|
OG content at 1 day before starting OG feed /BW, mean ± SD
|
10.4 ± 7.1
|
8.8 ± 6.3
|
11.9 ± 7.6
|
0.125
|
First oral feed at POD, mean ± SD
|
11.9 ± 7.2
|
7.7 ± 3.2
|
16.1 ± 7.7
|
0.000
|
Full feed at POD, mean ± SD
|
15.6 ± 8.3
|
12.5 ± 5.3
|
18.8 ± 9.7
|
0.007
|
Number of dates from start feed to full feed, mean ± SD
|
8.7 ± 7.2
|
5.9 ± 4.8
|
11.5 ± 8.3
|
0.006
|
Start feed at POD, mean ± SD
|
6.9 ± 2.6
|
6.6 ± 1.7
|
7.3 ± 3.2
|
0.314
|
day2, n (%)
|
1(2.0)
|
0
|
1(4.0)
|
|
day3, n (%)
|
2(3.9)
|
1(3.9)
|
1(4.0)
|
|
day4, n (%)
|
5(9.8)
|
1(3.9)
|
4(16.0)
|
|
day5, n (%)
|
8(15.7)
|
6(23.0)
|
2(8.0)
|
|
day6, n (%)
|
7(13.7)
|
6(23.0)
|
1(4.0)
|
|
day7, n (%)
|
7(13.7)
|
2(7.7)
|
5(20.0)
|
|
day8, n (%)
|
11(21.6)
|
7(26.9)
|
4(16.0)
|
|
day9, n (%)
|
3(5.9)
|
2(7.7)
|
1(4.0)
|
|
day10, n (%)
|
4(7.8)
|
1(3.9)
|
3(12.0)
|
|
day12, n (%)
|
2(3.9)
|
0
|
2(8.0)
|
|
day16, n (%)
|
1(2.0)
|
0
|
1(4.0)
|
|
Max advanced feed volume per day, mean ± SD
|
7.2 ± 4.5
|
9.5 ± 4.7
|
4.9 ± 2.9
|
0.000
|
** Student t-test (normal) > OG content at 1 day before starting OG feed, OG content/BW, start oral feed at POD, full feed at POD for analysis, number of dates from start feed to full feed, Start feed at POD, Max advanced feed volume per day |
The overall increment rate of feeding ranged from 1.92 to 19.56 ml/kg/day; the FF group had on average advanced volume(s) of feed per day more than the SF group (9.5 ± 4.7 vs 4.9 ± 2.9, p < 0.001 - Table 2. According to Table 3 - medical pediatricians tended to feed in slowly advanced incremental rates (FF; n = 16, SF; n = 19 patients) whereas the pediatric surgeons preferred a fast fed-rate (FF; n = 10, SF; n = 6 patients) ;p = 0.266. Surgeons also preferred feeding newborns in higher daily volumes vs pediatricians (FF: 10.2 ± 4.7 vs 8.9 ± 4.8, p = 0.343; SF: 6.2 ± 2.9 vs 4.1 ± 1.7, p = 0.175). The practice of gastric content monitoring under whoever was designated responsible for patients’ feeds was statistically insignificant (FF: 20.0% vs 18.8%, p = 0.939, SF: 16.7% vs 42.1%, p = 0.364). Of note in both study cohort groups no single patient developed NEC or other feeding-related complications.
Table 3
Categorized details of feed schedules according to pediatrician and surgeons
variable
|
Ped
(n = 35)
|
Ped Sx
(n = 16)
|
p-value
|
Fast fed group (n = 26)
|
16
|
10
|
|
Gastric content monitoring, n (%)
|
|
|
|
No
|
13(81.3)
|
8(80.0)
|
0.939
|
Yes
|
3(18.8)
|
2(20.0)
|
|
Max advanced feed-volume per day, mean ± SD
|
8.9 ± 4.8
|
10.2 ± 4.7
|
0.343
|
Slow fed group (n = 25)
|
19
|
6
|
|
Gastric content monitoring, n (%)
|
|
|
|
No
|
11(57.9)
|
5(83.3)
|
0.364
|
Yes
|
8(42.1)
|
1(16.7)
|
|
Max advanced feed-volume per day, mean ± SD
|
4.1 ± 1.7
|
6.2 ± 2.9
|
0.175
|
** Fisher's exact test > Gastric content monitoring |
Student-t test > Max advanced feed-volume per day |
Comparing FF and SF groups (Table 2) no differences in the mean postoperative date of first feeding were observed 6.6 ± 1.7 vs 7.3 ± 3.2 (p = 0.314). Statistically significant differences were however noted in the first oral-fed date (POD 7.7 ± 3.2 vs 16.1 ± 7.7: p < 0.001) and of the first full-fed date (POD 12.5 ± 5.3 vs 18.8 ± 9.7: p < 0.01). We also observed marked differences in the number of dates to achieve ‘step-up feeding’ comparing the study groups (5.9 ± 4.8 vs 11.5 ± 8.3: p < 0.01).