A randomized trial to assess advancement of enteral feedings following surgery for hypertrophic pyloric stenosis. Markel T.A., Scott M.R., Stokes S.M., & Ladd A.P. 2016.
A randomized trial to assess advancement of enteral feedings following surgery for hypertrophic pyloric stenosis [link]Paper  abstract   bibtex   
Purpose: The rate of feeding advancement following surgery for hypertrophic pyloric stenosis (HPS) affects length of stay. We hypothesized that: 1) a relaxed feeding regimen following pyloromyotomy would allow infants to achieve feeding goals more quickly without affecting postoperative emesis, and 2) preoperative metabolic derangements would impair the ability to advance feedings following pyloromyotomy. Methods: A prospective, randomized trial compared two postoperative feeding methods. The primary outcome was length of time to tolerate two consecutive goal feeds (GFs). Infants were randomized into the Incremental-arm (N = 74), in which infants were gradually advanced on enteral formula, or the Relaxed-arm (N = 69), in which infants were allowed to consume up to GF immediately. Preoperative variables, time to GF, preoperative laboratory values, and postoperative emesis were recorded. A p-value less than 0.05 was significant. Results: Patient demographics, pyloric ultrasound measurements, and episodes of postoperative emesis were similar between groups. Infants in the Relaxed-arm reached GF more quickly than those in the Incremental-arm and had a shorter length of stay (p. \textless. 0.001). Infants with preoperative serum chloride less than 100. mmol/L reached GF more slowly than those with normal labs (p. \textless. 0.03). Conclusion: Following surgery for HPS, surgeons can safely utilize a relaxed, nonstructured feeding regimen, which may allow infants to reach feeding goals more quickly without untoward vomiting. Level of evidence: Level 1-therapeutic. Copyright © 2016 Elsevier Inc.
@misc{markel_t.a._randomized_2016,
	title = {A randomized trial to assess advancement of enteral feedings following surgery for hypertrophic pyloric stenosis},
	url = {http://www.elsevier.com/inca/publications/store/6/2/3/1/4/8/index.htt},
	abstract = {Purpose: The rate of feeding advancement following surgery for hypertrophic pyloric stenosis (HPS) affects length of stay. We hypothesized that: 1) a relaxed feeding regimen following pyloromyotomy would allow infants to achieve feeding goals more quickly without affecting postoperative emesis, and 2) preoperative metabolic derangements would impair the ability to advance feedings following pyloromyotomy. Methods: A prospective, randomized trial compared two postoperative feeding methods. The primary outcome was length of time to tolerate two consecutive goal feeds (GFs). Infants were randomized into the Incremental-arm (N = 74), in which infants were gradually advanced on enteral formula, or the Relaxed-arm (N = 69), in which infants were allowed to consume up to GF immediately. Preoperative variables, time to GF, preoperative laboratory values, and postoperative emesis were recorded. A p-value less than 0.05 was significant. Results: Patient demographics, pyloric ultrasound measurements, and episodes of postoperative emesis were similar between groups. Infants in the Relaxed-arm reached GF more quickly than those in the Incremental-arm and had a shorter length of stay (p. {\textless}. 0.001). Infants with preoperative serum chloride less than 100. mmol/L reached GF more slowly than those with normal labs (p. {\textless}. 0.03). Conclusion: Following surgery for HPS, surgeons can safely utilize a relaxed, nonstructured feeding regimen, which may allow infants to reach feeding goals more quickly without untoward vomiting. Level of evidence: Level 1-therapeutic. Copyright © 2016 Elsevier Inc.},
	journal = {Journal of Pediatric Surgery},
	author = {{Markel T.A.} and {Scott M.R.} and {Stokes S.M.} and {Ladd A.P.}},
	year = {2016},
	keywords = {*enteric feeding, *hypertrophic pylorus stenosis, *length of stay, *postoperative vomiting, *pyloromyotomy, chloride blood level, controlled clinical trial, controlled study, human, human tissue, infant, major clinical study, randomized controlled trial, statistical significance, surgeon, surgery, ultrasound}
}
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