From
StayCurrentMD
Journal of Pediatric Surgery Article Review: September 2021
With Dr. Julian Goddard & Dr. Iris Limbuel · hosted by Dr. Rod Gerardo & Dr. Ellen Encisco
Chapter 1 of 4 · Evidence & Research
Introduction
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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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 didn't find any benefit in neonates
In the early feeding group, patients did not have a decompressing nasogastric tube
Nasogastric decompression is not needed after an anastomosis in neonates
The two groups had the same outcomes despite one group not having NG decompression, indicating NG tubes are not necessary after baby anastomosis
Babies with blood in their stool enough to cause a decrease in hemoglobin is a red flag sign for Meckel's diverticulum
If the Meckel's predictive score is high, one could go straight to laparoscopy because even with a negative Meckel scan, it's likely a Meckel's diverticulum
The Meckel's score could help tip the scale of skipping the Meckel scan in certain subset of patients
The Cincinnati study included all children from 0 to 18 years who lived within a 15 mile radius of Cincinnati Children's and presented with perianal disease
A second cohort included all children within a 50 mile radius who were diagnosed with Crohn's disease
Overall, 3% of children presenting with perianal symptoms ended up being diagnosed with Crohn's disease
No children under the age of 1 had Crohn's disease within the study period
Higher rates of Crohn's disease are seen in older children, particularly over the age of 10
The study included patients who had their perianal symptoms dealt with as an outpatient, who may not have been seen by the surgical team
Under the age of 10, you do not need to worry about doing a workup for Crohn's disease in children with perianal symptoms
Over the age of 10, you should do a workup for Crohn's disease in children with perianal symptoms
Quite a few children with Crohn's disease present with a perirectal abscess rather than GI symptoms like abdominal pain or diarrhea
In the Chinese study, the early feeding group started feeds at 2 days compared to 6 days for the traditionally fed 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