How do we feed the surgical newborns?

Öz

Objective: In this study we aimed to investigate the type of enteral feeding in newborns that have been operated for various reasons. Materials and methods: We investigated retrospectively the cases which were diagnosed, treated and followed up in our surgical intensive care unit between 2001 and 2002. All cases were studied according to their age at presentation, weight, initiation and mode of oral feeding. Six groups were setup for the investigation: patients with laparatomy and resection anastomosis (group 1), patients with laparatomy without intestinal resection anastomosis (group 2), patients with stoma (group 3), patients operated for esophageal atresia (group 4), patients with toracotomy (group 5) and the others (sacrococcygeal teratoma, urinary system pathologies etc, group 6). Results: 44 cases were included in our study. Female/male ratio was 1/3 and the mean age at presentation was 3, 4 days (1-33). The mean weight was 2695 gm (12863960). Group1 (n=11): The mean duration between operation and initiation of enteral feeding was 4, 8 days (1-6). While 9 cases were being fed orally 2 cases were started nasogastric feeding. Feeding was in the mode of 3+1 (3 hours continuously + 1 hour interval and checking residue). Feeding was increased gradually according to the amount of residue. Group 2 (n=8): The mean duration between operation and initiation of enteral feeding in these cases was 3, 5 days (1-14) and the mean amount was 9,5cc (2-30). All the cases were started to be fed orally and increased gradually. Group 3 (n=10): The mean duration between operation and initiation of enteral feeding in these cases was 1,5 days (1-3) and the mean amount was 5cc. Group 4 (n=8): In esophagial atresia cases duration of time of starting feeding was 4,3 days (3-6). 5 cases were started orally and 3 cases with nasogastric mode with the amount of 3,3cc (3-5). Group 5 (n=2): Cases with toracotomy were fed posoperatively on day 1 with 5cc. Group 6 (n=6): All other cases were fed postoperatively on day 1 with 15cc (5-30). Conclusion: In this study, the cases in which intestinal resection was performed were found to be fed latest and oral feeding was the type of feeding preference. Except for the clinically high risk cases (short bowel syndrome, sepsis and ventilator therapy) postoperative early enteral feeding can be tolerated easily in the newborn patients and with this feeding strategy the complications of parenteral feeding can be avoided.

Anahtar Kelimeler

• Retrospective Studies,Infant, Newborn,Surgical Procedures, Operative,Nutrition,Feeding Methods

Cerrahi yenidoğanları nasıl besliyoruz?

Öz

Amaç: Bu çalışmada kliniğimizde değişik endikasyonlarla ameliyat edilen yenidoğanlarda beslenme şekillerinin irdelenmesi amaçlandı. Gereç ve Yöntem: Cerrahi yenidoğan yoğun bakım ünitemizde 2001-2002 yılları arasında teşhis ve tedavi edilen ve beslenme kayıtları düzenli tutulmuş olgular geriye dönük olarak irdelendi. Olgular başvuru yaşı, ağırlık, oral beslenmeye başlama zamanı ve şekli açısından incelendi. Olgular laparatomi ve rezeksiyon anostomoz yapılan (Grup 1), rezeksiyon anostomoz yapılmayan (Grup 2), stoma açılan (Grup 3), özofagus atrezisi nedeni ile opere edilen (Grup 4), torokotomi yapılan (Grup 5) ve diğerleri (Grup 6) (sakrokoksigeal teratom, üriner sistem patolojileri vb) olmak üzere 6 farklı grupta irdelendi. Bulgular: Toplam 44 olgu değerlendirmeye alındı. Kız/ erkek oranı 1/3 idi. Ort. başvuru yaşı 3,4 gün (133), ort. ağırlık ise 2695 gr (1286-3960) idi. Grup 1 (n=11): Bu olguların ortalama enteral beslenmeye başlama zamanı 4,8 gün (1-6) idi, 9 olgu oral beslenirken, 2 olgu da nazogastrik gavajla beslenmeye başlandı. Beslenme 3+1 (3 saat sürekli + 1saat ara & residiv bakma) şeklinde uygulandı. Residiv miktarına göre kademeli arttırmaya gidildi. Grup 2 (n=8): Bu olgularda beslenmeye başlanma zamanı ise ort. 3,5 gün (1-14), ort. beslenme miktarı ise 9,5 cc (2-30) idi. Tamamı oral beslenme ile başlanıp ve beslenme miktarı günlük kademeli arttırılarak devam edildi. Grup 3 (n=10): Bu olguların ort. beslenme zamanı 1,5 gün (1-3), beslenme miktarı 5 cc ve tamamı oral idi. Grup 4 (n=8): Özefagus atrezili olgularda ort. beslenmeye başlama zamanı 4,3 gün (3-6) idi. Olguların 5'i oral, 3'ü nazogastrik gavajla, ort. 3,3 cc (3-5) ile beslenmeye başlandı. Grup 5 (n=2): Torakotomi yapılan olgular ise postop 1. gün 5cc ile oral beslenmeye başlandı. Grup 6 (n=5): Diğer nedenlerle olguların tamamı postop 1. gün ort. 15 cc (5-30) ile oral beslenmeye başlandı. Sonuç: Çalışmamızda GI sistemde rezeksiyon yapılan olgular en geç beslenmeye alınan grup olarak gözlenmiş, oral beslenme sıklıkla başlangıç için tercih edilen metod olmuştur. Bu parenteral beslenmenin meydana getireceği komplikasyonları da engellemiş olmaktadır.

Anahtar Kelimeler

• Geriyedönük çalışma,Süt çocuğu, yenidoğan,Cerrahi işlemler, operatif,Beslenme,Beslenme yöntemleri

Kaynakça

1. 1.James A. O Neil, JR. Nutritional Support: Principles of Pediatric Surgery. Second Edition
2. Mosby 2003, 87-103 2.Lewis A.B, Jhon S.C. Nutrition. Waldo E.N
3. Nelson Textbook of Pediatrics. W.B. Saunders Company. 1996 141-184 3.Dudrick SJ, Wilmore D W, Vars HM, Rhoads JE Long-term total parenteral nutrition with growth, development, and positive nitrogen balance
4. Surgery. 1968 ;64 Carol L Berseth. Feeding methods for the preterm infant: Semin Neonatal 2001, 6: 417-424 4.Carol L Berseth. Feeding methods for the preterm infant: Semin Neonatal 2001, 6: 417-424 5.Macagno F, Demarini S. Techniques of enteral feeding in the newborn. Acta Paediatr Suppl. 1994; 402: 11-3 6.Suri S, Eradi B, Chowdhary SK, Narasimhan KL, Rao KL.Early postoperative feeding and outcome in neonates. Nutrition. 2002; 18: 380-2 7.Danniel H. Teitelbaum, Arnold G. Coran
5. Nutrition. James A. O'Neill, and at all: Pediatrc surgery, 5th Edition. Mosby-Year book, Missouri, USA, 1998: 1381-1424 (1):134-42
6. 8.Ekingen G, Ceran G, Güvenç BH Tuzlacı A, Kahraman H. Early enteral feeding in newborn surgical patients. Nutrition. 2005 Feb;21(2):142-6
7. 9.Richard J. Schanler, Robert J. Shulman, and Chantal Lau Feeding Strategies for Premature Infants: Beneficial Outcomes of Feeding Fortified Human Milk Versus Preterm Formula Pediatrics 1999; 103: 1150-1157 10.Teitelbaum DH, Tracy T. Parenteral nutrition-associated cholestasis. Semin Pediatr Surg. 2001;10:72-80 11.Yasuhiro O, Nigel K, H.K.F. Van Saene, Agostino P. Smal Volumes of Enteral Feeding Normalise Immune Fuction in Infants Receiving Parenteral Nutrition. Journal Of Pediatric Surgery 1998; 33: 16-19 12.Ordaz-Jimenez MR, Fernandez-Celis JM, Rivera-Rosas S, Serrano-Camargo C, Ballesterosdel-Olmo JC, Estrada-Flores JV. Gastrointestinal hormones during minimal enteral feeding of sick premature infants. Rev Invest Clin. 1998; 50:37-42 13.Strodtbeck F. The role of early enteral nutrition in protecting premature infants from sepsis. Crit Care Nurs Clin North Am. 2003; 15: 79-87 14.Akova F, İlçe Z, Koksal F, Celayir S. Cerrahi yenidoğan yoğun bakım ünitesinde sepsis olgularının değerlendirilmesi. Cerrahpaşa Tıp Derg2001; 32: 214-220 15.Troche B, Harvey-Wilkes K, Engle WD, Nielsen HC, Frantz İD 3rd, Mitchell ML, Hermos RJ. Early minimal feedings promote growth in critically ill premature infants. Biol Neonate. 1995; 67: 172-81 16.Simpson C, Schanler RJ, Lau C. Early introduction of oral feeding in preterm infants
8. Pediatrics. 2002; 110: 517-22 17.Bohnhorst B, Muller S, Dordelmann M, Peter CS, Petersen C, Poets CF. Early feeding after necrotizing enterocolitis in preterm infants. J Pediatr. 2003; 143: 484-7 18.Ostertag SG, LaGamma EF, Reisen CE, Ferrentino FL. Early enteral feeding does not affect the incidence of necrotizing enterocolitis

9. Pediatrics. 1986; 77: 275-80