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Use of trans-anastomotic tubes in congenital duodenal obstruction

Use of trans-anastomotic tubes in congenital duodenal obstruction
Use of trans-anastomotic tubes in congenital duodenal obstruction
Aim : Despite data to suggest benefit of trans- anastomotic tube (TAT) feeding in infants following repair of congenital duodenal obstruction (CDO), TAT usage is limited. We aimed to report a large series of infants with CDO treated with or without TAT in order to improve the evidence underlying this simple intervention. Method : Single centre retrospective review of all infants CDO over a 20-year period (January 1999 – November 2020, inclusive). Important outcomes were compared between infants treated with or without TAT. Data are median [IQR]. Results : Ninety-six infants were included. A TAT was placed in 54 infants (56%). Median time to full enteral feed was significantly shorter in the TAT group (6 [5-8] days vs 10 [7.5-12], p <0.001). Time to first feed was shorter in the TAT group (2 [2-2.8] days vs 3 [2-5], p<0.001). Significantly fewer infants with a TAT placed received a central venous catheter (CVC, 15% vs 76%, p <0.001). Infants without a TAT received parenteral nutrition (PN) for longer (0 [0-0] vs 7 [0-11] days, p <0.001). There was no change in length of stay between TAT and no TAT group (16 [13-21.8] vs 15 [12-21.8] days, p=0.722). Eight infants (15%) in the TAT group required a CVC and PN. One infant in the TAT group developed a perforation that required surgical management and nine infants in the non-TAT group had complications related to the CVC (21%), including one infant that required general anaesthetic for tunnelled central line placement (2.3%). Conclusion : In infants with CDO, TAT use was associated with earlier establishment of full enteral feeds, reduced need for CVC and PN and reduced complications. Further research should focus on the barriers to wider use of TAT by surgeons and neonatologists in infants with CDO.
Congenital duodenal obstruction, Duodenal atresia, Parenteral nutrition, Transanastomotic tube
0022-3468
45-48
Cresner, Rosie
6208f433-9f7f-4df1-b467-41489515a8de
Neville, Jonathan J
b3ae31fa-8d61-4805-a923-b7889b90cbae
Drewett, Melanie
efe2ca78-355a-454e-8b60-5b1a11ded289
Hall, Nigel
6919e8af-3890-42c1-98a7-c110791957cf
Darwish, Ahmed A
53e433a2-a32f-4966-ba05-0083096668e1
Cresner, Rosie
6208f433-9f7f-4df1-b467-41489515a8de
Neville, Jonathan J
b3ae31fa-8d61-4805-a923-b7889b90cbae
Drewett, Melanie
efe2ca78-355a-454e-8b60-5b1a11ded289
Hall, Nigel
6919e8af-3890-42c1-98a7-c110791957cf
Darwish, Ahmed A
53e433a2-a32f-4966-ba05-0083096668e1

Cresner, Rosie, Neville, Jonathan J, Drewett, Melanie, Hall, Nigel and Darwish, Ahmed A (2022) Use of trans-anastomotic tubes in congenital duodenal obstruction. Journal of Pediatric Surgery, 57 (9), 45-48. (doi:10.1016/j.jpedsurg.2022.01.049).

Record type: Article

Abstract

Aim : Despite data to suggest benefit of trans- anastomotic tube (TAT) feeding in infants following repair of congenital duodenal obstruction (CDO), TAT usage is limited. We aimed to report a large series of infants with CDO treated with or without TAT in order to improve the evidence underlying this simple intervention. Method : Single centre retrospective review of all infants CDO over a 20-year period (January 1999 – November 2020, inclusive). Important outcomes were compared between infants treated with or without TAT. Data are median [IQR]. Results : Ninety-six infants were included. A TAT was placed in 54 infants (56%). Median time to full enteral feed was significantly shorter in the TAT group (6 [5-8] days vs 10 [7.5-12], p <0.001). Time to first feed was shorter in the TAT group (2 [2-2.8] days vs 3 [2-5], p<0.001). Significantly fewer infants with a TAT placed received a central venous catheter (CVC, 15% vs 76%, p <0.001). Infants without a TAT received parenteral nutrition (PN) for longer (0 [0-0] vs 7 [0-11] days, p <0.001). There was no change in length of stay between TAT and no TAT group (16 [13-21.8] vs 15 [12-21.8] days, p=0.722). Eight infants (15%) in the TAT group required a CVC and PN. One infant in the TAT group developed a perforation that required surgical management and nine infants in the non-TAT group had complications related to the CVC (21%), including one infant that required general anaesthetic for tunnelled central line placement (2.3%). Conclusion : In infants with CDO, TAT use was associated with earlier establishment of full enteral feeds, reduced need for CVC and PN and reduced complications. Further research should focus on the barriers to wider use of TAT by surgeons and neonatologists in infants with CDO.

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TAT for Duodenal atresia manuscript 2021 R2 clean Jan 4 2021 - Accepted Manuscript
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1-s2.0-S002234682200121X-main (1) - Proof
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More information

Accepted/In Press date: 31 January 2022
e-pub ahead of print date: 6 February 2022
Published date: September 2022
Additional Information: Funding Information: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Keywords: Congenital duodenal obstruction, Duodenal atresia, Parenteral nutrition, Transanastomotic tube

Identifiers

Local EPrints ID: 454937
URI: http://eprints.soton.ac.uk/id/eprint/454937
ISSN: 0022-3468
PURE UUID: fc868bde-4c0b-42fb-b0e6-e652cb2ef4e8
ORCID for Nigel Hall: ORCID iD orcid.org/0000-0001-8570-9374

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Date deposited: 02 Mar 2022 17:32
Last modified: 01 Feb 2023 02:42

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Contributors

Author: Rosie Cresner
Author: Jonathan J Neville
Author: Melanie Drewett
Author: Nigel Hall ORCID iD
Author: Ahmed A Darwish

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