Congenital duodenal obstruction repair with and without trans-anastomotic tube feeding – a systematic review and meta-analysis
Congenital duodenal obstruction repair with and without trans-anastomotic tube feeding – a systematic review and meta-analysis
Objective: To determine the impact of transanastomotic tube (TAT) feeding in congenital duodenal obstruction (CDO). Design: Systematic review with meta-analysis. Patients: Infants with CDO requiring surgical repair. Interventions: TAT feeding following CDO repair versus no TAT feeding. Main outcome measures: The main outcome was time to full enteral feeds. Additional outcomes included use of parenteral nutrition (PN), cost and complications from either TAT or central venous catheter. Meta-analyses were undertaken using random-effects models (mean difference (MD) and risk difference (RD)), and risk of bias was assessed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool. Results: Twelve out of 373 articles screened met the inclusion criteria. All studies were observational and two were prospective. Nine studies, containing 469 infants, were available for meta-analysis; however, four were excluded due to serious or critical risk of bias. TAT feeding was associated with reduced time to full enteral feeds (-3.34; 95% CI -4.48 to -2.20 days), reduced duration of PN (-6.32; 95% CI -7.93 to -4.71 days) and reduction in nutrition cost of £867.36 (95% CI £304.72 to £1430.00). Other outcomes were similar between those with and without a TAT including inpatient length of stay (MD -0.97 (-5.03 to 3.09) days), mortality (RD -0.01 (-0.04 to 0.01)) and requirement for repeat surgery (RD 0.01 (-0.03 to 0.05)). Conclusion: TAT feeding following CDO repair appears beneficial, without increased risk of adverse events; however, certainty of available evidence is low. Earlier enteral feeding and reduced PN use are known to decrease central venous catheter-associated risks while significantly reducing cost of care. PROSPERO registration number: CRD42022328381.
Gastroenterology, Neonatology
Bethell, George S.
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Neville, Jonathan
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Johnson, Mark
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Turnbull, Joanne
cd1f8462-d698-4a90-af82-46c39536694b
Hall, Nigel J.
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Bethell, George S.
c7a62cc1-5573-41f6-ae00-3c11e8219dd4
Neville, Jonathan
b3ae31fa-8d61-4805-a923-b7889b90cbae
Johnson, Mark
6e0d848a-be85-4b3a-8c16-479989e3bf22
Turnbull, Joanne
cd1f8462-d698-4a90-af82-46c39536694b
Hall, Nigel J.
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Bethell, George S., Neville, Jonathan, Johnson, Mark, Turnbull, Joanne and Hall, Nigel J.
(2023)
Congenital duodenal obstruction repair with and without trans-anastomotic tube feeding – a systematic review and meta-analysis.
Archives of Disease in Childhood, [archdischild-2023-325988].
(doi:10.1136/archdischild-2023-325988).
Abstract
Objective: To determine the impact of transanastomotic tube (TAT) feeding in congenital duodenal obstruction (CDO). Design: Systematic review with meta-analysis. Patients: Infants with CDO requiring surgical repair. Interventions: TAT feeding following CDO repair versus no TAT feeding. Main outcome measures: The main outcome was time to full enteral feeds. Additional outcomes included use of parenteral nutrition (PN), cost and complications from either TAT or central venous catheter. Meta-analyses were undertaken using random-effects models (mean difference (MD) and risk difference (RD)), and risk of bias was assessed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool. Results: Twelve out of 373 articles screened met the inclusion criteria. All studies were observational and two were prospective. Nine studies, containing 469 infants, were available for meta-analysis; however, four were excluded due to serious or critical risk of bias. TAT feeding was associated with reduced time to full enteral feeds (-3.34; 95% CI -4.48 to -2.20 days), reduced duration of PN (-6.32; 95% CI -7.93 to -4.71 days) and reduction in nutrition cost of £867.36 (95% CI £304.72 to £1430.00). Other outcomes were similar between those with and without a TAT including inpatient length of stay (MD -0.97 (-5.03 to 3.09) days), mortality (RD -0.01 (-0.04 to 0.01)) and requirement for repeat surgery (RD 0.01 (-0.03 to 0.05)). Conclusion: TAT feeding following CDO repair appears beneficial, without increased risk of adverse events; however, certainty of available evidence is low. Earlier enteral feeding and reduced PN use are known to decrease central venous catheter-associated risks while significantly reducing cost of care. PROSPERO registration number: CRD42022328381.
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ADC TAT SR - final accepted version (002)
- Accepted Manuscript
More information
Accepted/In Press date: 1 September 2023
e-pub ahead of print date: 3 November 2023
Additional Information:
Funding Information:
This research is funded by a National Institute of Health Research (NIHR) research for patient benefit grant (NIHR203611). GSB is funded by the NIHR Doctoral Fellowship Programme (NIHR302541). JJN is funded by an NIHR academic clinical fellowship. MJJ is funded by the NIHR Southampton Biomedical Research Centre.
Publisher Copyright:
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
Keywords:
Gastroenterology, Neonatology
Identifiers
Local EPrints ID: 481832
URI: http://eprints.soton.ac.uk/id/eprint/481832
ISSN: 0003-9888
PURE UUID: 5717fab3-c635-4139-845a-345f6611edb0
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Date deposited: 11 Sep 2023 16:35
Last modified: 18 Mar 2024 04:09
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Author:
George S. Bethell
Author:
Jonathan Neville
Author:
Mark Johnson
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