Purpose: The optimal feeding regimen for neonates after pyloromyotomy for hypertrophic pyloric stenosis (HPS) remains controversial. This study sought to compare ad libitum feeding to a Conventional feeding regimen with regard to time to full diet, length of hospital stay, and readmission rates.
Methods: A 6-month review of 36 consecutive patients who underwent pyloromyotomy for HPS was undertaken. Patients were fed in 1 of 2 ways according to specific surgeon preference. Conventional Regimen patients (n = 19) were kept nothing by mouth (NPO) for 6 hours after surgery and incrementally advanced to full feedings. ad libitum (n = 17) patients were kept NPO until fully reversed from anesthesia and then given full strength formula or breast milk. Discharge was considered when 2 feedings of 60 mL were tolerated.
Results: Twenty-eight males and 8 females with a mean age of 5.0 plus minus 1.7 (SD) weeks, gestational age of 39 plus minus 2.1 weeks, weight of 4.0 plus minus 0.9 kg, and operating time of 56 plus minus 12 minutes were studied. The interval from operating room to full diet was significantly less with ad libitum feeding than on the conventional regimen (20.3 plus minus 5.0 v. 25.4 plus minus 8.3 hours, P <.05). The Ad Libitum group also had a significantly decreased length of hospital stay (28.5 plus minus 8.9 hours v. 35.8 plus minus 11 hours; P <.05). There were no readmissions in either group.
Conclusions: Ad libitum feedings decrease time to full diet and discharge without an increase in readmission rates. The estimated potential savings per patient using ad libitum feedings were $392.00. Thus, the use of ad libitum feedings after pyloromyotomy for HPS appears indicated.
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