INTRAOPERATIVE VOLUME PREDICTS TIME TO START FEEDS AFTER ELECTIVE ABDOMINAL SURGERY IN NEONATES
Devon A. Gingrich*, Sydni Imel, Lauren Hoff, Anjali Vaishnav, Marissa Martinelli, Jorge Vinales, Brianna L. Spencer, Dimitra M. Lotakis, K. E. Speck, Samir Gadepalli
University of Michigan Medical School, Ann Arbor, MI
Introduction: Higher perioperative volume during elective abdominal surgery leads to delayed return of bowel function in adults. Given the paucity of evidence in the neonatal population, we sought to evaluate the relationship between perioperative volume and return of bowel function in this population.
Methods: After IRB approval, a retrospective chart review (2016-2021) identified 70 neonates (0-52 weeks) who underwent an elective surgery with a bowel anastomosis. Patients were excluded (n=7) for sepsis at time of surgery, postoperative infection or anastomotic leak, surgery classified as emergent/urgent, need for parenteral nutrition at discharge, or missing data. Data collected included demographics (age, race, gender, weight at surgery), perioperative variables (volume administered (mL/kg) including blood products, type of surgery and anastomosis, narcotic use), and outcomes (time to start and reach goal enteral feeds, length of ICU and hospital stay, days on ventilator and TPN). Return of bowel function was defined as the start of enteral feeds in the neonatal population. Descriptive statistics and linear regression were performed, with p < 0.05 considered significant.
Results: 63 neonatal patients (65% male, 76% white, median age 6wks (IQR 23), median weight 4.04 kg (IQR 3.24) underwent elective surgery including bowel anastomosis (small bowel to small bowel (n=37), colon to colon/rectum (n=15), small bowel to colon/rectum (n=8), or other (n=3)). The median length of operation was 179 minutes (IQR 125). The median volume of intraoperative fluids was 38mL/kg (IQR 29) and a median perioperative (intraop + postop day (POD) 0-2) volume of 180 mL/kg (IQR 105). 61 patients (97%) received intraop narcotics (mean 1.3 +/- 1.3 morphine milliequivalents). Enteral nutrition was resumed at a median of 3 days postop (IQR 4) and goal feeds achieved at a median of 8 days postop (IQR 13). On multivariate analysis, the start of feeds was correlated with intraoperative volume (p<0.001), length of operation (p=0.001), but not weight at time of surgery (p=0.16) or narcotic use (p=0.3). The volume administered during surgery explains nearly 24% of the variation in the start of feeds with a slope of 0.1 (see figure).
Conclusions: The amount of intraoperative volume administered during elective abdominal surgery significantly impacted the start of feeds in neonates. In our series, for each 10 mL/kg of additional volume administered at surgery, the start of feeds was extended by 1 day.
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