Early Enteral Feeding After Closure of Colostomy in Pediatric Patients By Surasak Sangkhathat, Sakda Patrapinyokul, and Kamolnate Tadyathikom Songkhla, Thailand Background/Purpose: The aim of this study was to deter- mine the benefits and adverse effects of protocolized early postoperative enteral feeding in pediatric patients undergo- ing a closure of colostomy. Methods: Pediatric patients, completely treated for anorectal malformation, who underwent a closure of colostomy during September 2000 and May 2002 received early postoperative feeding according to the authors’ protocol (EF group). Retro- spective data of consecutive patients operated on from March 1998 to August 2000 who received traditional feeding practice were used as a control (TF group). The protocol began with a small volume of formula or breast feeding within the first postoperative day. Volume allowance was advanced every 4 hours up to the daily maintenance volume. Full feeding was defined as when the patient was able to tolerate at least 80% of daily maintenance volume. TF group received nothing by mouth until documentation of bowel function. The groups were compared with regard to postop- erative stay, postoperative hour of full feeding, first bowel movement, and adverse effects. Statistical analyses were performed with  2 test, Student’s t test, and Mann-Whitney U test. Results: There were 34 and 30 patients in EF and TF groups, respectively. Median age of the patients was 13 months, and median weight was 8.39 kg. Except for the associated anom- alies, which were found more in the EF group, there were no differences in the demographic characteristics of the 2 groups. On average, feeding was initiated at 19.7 (16 to 24) hours in the EF group and 51.7 (18 to 92) hours in the TF group (P  .01). Median full feeding hours were 45.5 and 70.5 hours in the EF and TF group, respectively (P  .01). First bowel movement in the EF group was recorded at the aver- age of 4.14 postoperative nurse shifts, compared with 5.96 shifts in the TF group (P  .01). Postoperative stay was significantly reduced from the average of 6.1 days to 4.5 days (P  .01). The overall hospital expenses were not signifi- cantly different between the 2 groups. ($203.95 US in TF group and $198.50 US in EF group; P = .75) There was 1 vomiting case in the EF group that was temporary and resolved spontaneously. Septic complications were noted in 8 patients in the EF group and 6 patients in the TF group (P = .27). The majority were uncomplicated urinary tract infections. Conclusions: Early feeding after a closure of colostomy in pediatric patients stimulated early bowel movement and reduced hospital stay with no increased adverse effects. J Pediatr Surg 38:1516-1519. © 2003 Elsevier Inc. All rights reserved. INDEX WORDS: Postoperative enteral feeding, pediatric sur- gical nutrition, paralytic ileus. T HE TRADITIONAL practice of postoperative star- vation after abdominal surgery recently has been challenged. Early enteral feeding has been shown by various clinical trials as having benefits in reduction of postoperative ileus and hospital stay. 1-4 Moreover, ex- perimental studies in peritonitis models have shown a therapeutic effect on the healing of colonic anastomo- ses. 5,6 In pediatric patients, early enteral feeding regi- mens were adopted in cases of upper gastrointestinal tract surgery, especially the pyloromyotomy for hyper- trophic pyloric stenosis. 7,8 However, such practice has not been reported in pediatric colonic surgery. The ob- jective of our study was to evaluate the benefits and adverse effects of an early enteral feeding regimen in pediatric patients after colonic procedures, using closure of colostomy as a model. MATERIALS AND METHODS From September 2000 to May 2002, 34 pediatric patients who had been completely treated for anorectal malformations underwent a closure of colostomy in the pediatric surgery unit, Songklanagarind Hospital. All of the patients were enrolled in our early feeding protocol under informed consent from their parents. According to the protocol, the enteral diet in this group (EF group) was begun within 24 hours, usually in the morning of the first postoperative day. For infants aged less than 2 years, the first feeding began with 30 mL of clean water. Infant formula then was given at 3- to 4-hour intervals with an initial volume of 30 mL. Volume allowance increased every 4 feedings up to the daily maintenance volume. The maximum allowance of infant formula usually did not exceed 720 mL. For breast-fed infants, ad lib breast feeding was allowed when the patients were tolerating 60 to 90 mL of formula feeding. Baby food was added on the third day for infants aged 6 months or more. Older patients received a clear liquid From the Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hadyai, Songkhla, Thailand. Supported by a grant from the Faculty of Medicine, Prince of Songkla University. Address reprint requests to Surasak Sangkhathat, MD, Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hadyai, Songkhla, Thailand 90110. © 2003 Elsevier Inc. All rights reserved. 0022-3468/03/3810-0016$30.00/0 doi:10.1016/S0022-3468(03)00506-2 1516 Journal of Pediatric Surgery, Vol 38, No 10 (October), 2003: pp 1516-1519