From
StayCurrentMD
Journal of Pediatric Surgery Article Review: September 2021
With Dr. Mick Kakaran & Dr. Julian Goddard & Dr. Iris Lim Butel · hosted by Dr. Rod Gerardo & Dr. Ellen Encisco
Chapter 1 of 2 · Evidence & Research
ERAS & Meckel score
Early feeding versus traditional feeding after neonatal intestinal anastomosis and Meckel diverticulum predictive score
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What the experts said
Although there is evidence that early feeding in adult patients after intestinal surgery is beneficial, the authors did not find any benefit in neonates.
Babies with blood in their stool causing a decrease in hemoglobin has always been a red flag sign for Meckel diverticulum.
A Cincinnati Children's study examined children aged 0-18 within a 15-mile radius who presented with perianal symptoms (abscess, fissure, fistula) to determine how often this represents Crohn disease.
Overall, 3% of children presenting with perianal symptoms were diagnosed with Crohn disease.
No children under age 1 with perianal abscess ended up having Crohn disease within the study period.
Higher rates of Crohn disease were seen in older children, particularly over age 10, among those presenting with perianal symptoms.
Many patients in the study had fissures, which are very common in children and may have been managed as outpatients.
Quite a few children with Crohn disease present with perirectal abscess rather than typical GI symptoms like abdominal pain and diarrhea.
A Chinese randomized multi-center trial of 156 neonates who underwent surgery for gastrointestinal malformation with intestinal anastomosis compared early internal feeding versus traditional nasogastric decompression.
The early feeding group started feeds at 2 days compared to 6 days in the traditional feeding group.
There was no significant difference between early and traditional feeding groups in length of stay, time to full feeds, postoperative complications, 30-day mortality, or 30-day readmissions.
In the early feeding group, patients did not have a decompressing nasogastric tube, suggesting nasogastric decompression is not needed after neonatal intestinal anastomosis.
A Utah study examined patients under age 18 who presented with hematochezia to identify which factors predict Meckel diverticulum and created a risk score.
The Meckel score could help clinicians skip the Meckel scan and go straight to laparoscopy in high-score patients, even with a negative scan.
Under age 10, clinicians do not need to worry about doing a workup for Crohn disease in children with perianal symptoms; over age 10, they should.