Abstract：
BACKGROUND: Evidence-based medicine guides clinical decision-making; however, promoting enteral nutrition has historically followed a dogmatic approach in which patients graduate from clear liquids to full liquids to a regular diet after return of bowel function. Enhanced recovery after surgery has demonstrated that early enteral nutrition initiation is associated with shorter hospital stays. We aimed to understand postoperative pediatric nutrition practices in Kenya and the United States.
METHODS: We completed a prospective observational study of pediatric surgery fellows during clinical rounds in a pediatric referral center in Kenya (S4A) and one in the United States (Riley). Fellow-patient interactions were observed from postoperative day one to discharge or postoperative day 30, whichever happened first. Patient demographic, operative information, and daily observations including nutritional status were collected via REDCap.
RESULTS: We included 75 patients with 41 (54.7%) from Kenya; patients in Kenya were younger with 40% of patients in Kenya presenting as neonates. Median time to initiation and full enteral nutrition was shorter for the patients at Riley when compared to their counterparts at S4A. In the neonatal subgroup, patients at S4A initiated enteral nutrition sooner, but their hospital length of stays were not significantly different.
CONCLUSIONS: Studying current nutrition practices may guide early enteral nutrition protocols. Implementing these protocols, particularly in a setting where enteral nutrition alternatives are minimal, may provide evidence of success and overrule dogmatic nutrition advancement. Studying implementation of these protocols in resource-constrained areas, where patient length of stay is often related to socioeconomic factors, may identify additional benefits to patients.
METHODS: We completed a prospective observational study of pediatric surgery fellows during clinical rounds in a pediatric referral center in Kenya (S4A) and one in the United States (Riley). Fellow-patient interactions were observed from postoperative day one to discharge or postoperative day 30, whichever happened first. Patient demographic, operative information, and daily observations including nutritional status were collected via REDCap.
RESULTS: We included 75 patients with 41 (54.7%) from Kenya; patients in Kenya were younger with 40% of patients in Kenya presenting as neonates. Median time to initiation and full enteral nutrition was shorter for the patients at Riley when compared to their counterparts at S4A. In the neonatal subgroup, patients at S4A initiated enteral nutrition sooner, but their hospital length of stays were not significantly different.
CONCLUSIONS: Studying current nutrition practices may guide early enteral nutrition protocols. Implementing these protocols, particularly in a setting where enteral nutrition alternatives are minimal, may provide evidence of success and overrule dogmatic nutrition advancement. Studying implementation of these protocols in resource-constrained areas, where patient length of stay is often related to socioeconomic factors, may identify additional benefits to patients.
摘要：
背景：循证医学指导临床决策；然而，从历史上看，促进肠内营养一直遵循教条式的方法，即患者在肠道功能恢复后，从透明液体过渡到完全液体，再到常规饮食。手术后的增强恢复表明，早期肠内营养开始与住院时间缩短有关。我们旨在了解肯尼亚和美国的术后儿科营养实践。
方法：我们在肯尼亚的一个儿科转诊中心（S4A）和美国的一个儿科转诊中心（Riley）完成了一项儿科手术研究员的前瞻性观察性研究。从术后第一天到出院或术后30天，以先发生者为准。患者人口统计，手术信息,通过REDCap收集每日观察,包括营养状况.
结果：我们纳入了75例患者，其中41例（54.7%）来自肯尼亚；肯尼亚患者较年轻，40%的肯尼亚患者为新生儿。与S4A的患者相比，Riley的患者开始和完全肠内营养的中位时间更短。在新生儿亚组中，S4A患者较早开始肠内营养，但他们的住院时间没有显著差异.
结论：研究当前的营养实践可以指导早期肠内营养方案。实施这些协议，特别是在肠内营养替代品很少的情况下，可能提供成功的证据，并推翻教条式的营养进步。研究这些协议在资源受限领域的实施，患者的住院时间通常与社会经济因素有关，可能会给患者带来额外的好处。
方法：我们在肯尼亚的一个儿科转诊中心（S4A）和美国的一个儿科转诊中心（Riley）完成了一项儿科手术研究员的前瞻性观察性研究。从术后第一天到出院或术后30天，以先发生者为准。患者人口统计，手术信息,通过REDCap收集每日观察,包括营养状况.
结果：我们纳入了75例患者，其中41例（54.7%）来自肯尼亚；肯尼亚患者较年轻，40%的肯尼亚患者为新生儿。与S4A的患者相比，Riley的患者开始和完全肠内营养的中位时间更短。在新生儿亚组中，S4A患者较早开始肠内营养，但他们的住院时间没有显著差异.
结论：研究当前的营养实践可以指导早期肠内营养方案。实施这些协议，特别是在肠内营养替代品很少的情况下，可能提供成功的证据，并推翻教条式的营养进步。研究这些协议在资源受限领域的实施，患者的住院时间通常与社会经济因素有关，可能会给患者带来额外的好处。
