Exploring the current usage of and attitudes towards trans-anastomotic tube (TAT) feeding in infants born with duodenal atresia: a survey of practice in the UK
Exploring the current usage of and attitudes towards trans-anastomotic tube (TAT) feeding in infants born with duodenal atresia: a survey of practice in the UK
Background: despite evidence demonstrating clinical and cost benefits of transanastomotic tubes (TATs), following repair of congenital duodenal obstruction they are used in a minority of infants in the UK. Most infants are fed using parenteral nutrition (PN) (sometimes in combination with a TAT). This variation is unexplained by clinical or demographic factors. We aimed to understand why this is and the barriers to practice change.
Methods: UK-based clinicians (surgeons, neonatologists, dietitians and specialist nurses) completed an online mixed methods survey. Open-ended replies were summarised thematically. Data were analysed using descriptive and inferential statistics.
Results: 109 clinicians (24 neonatologists, 7 nurses, 3 dietitians, 75 surgeons) from all 25 UK neonatal surgical units completed the survey. 88% (n=96/109) stated TAT use was decided solely by surgeons, driven primarily by considerations of providing appropriate nutrition and risks; 36% of surgeons felt TATs should always be used where possible. Decisions about central venous catheters (CVCs) were made by neonatologists (28%, n=31/109), surgeons (17%, n=18/109), jointly (48%, n=52/109) or ‘other’ (7%, n=8/109). Neonatologists and surgeons prioritised providing appropriate nutrition and risks when deciding whether to use CVCs/PN; surgeons rated a lack of supporting research and TATs’ risks as key barriers to TAT usage. Costs and parents’ preferences had limited influence on TAT and PN usage.
Conclusions: increased TAT usage requires surgeons to be persuaded of TATs’ efficacy and safety, and neonatologist recognition that exclusive TAT feeding (ie, without CVCs/PN) can provide adequate nutrition. Further work is required to appreciate how best to achieve this.
Attitude of Health Personnel, Duodenal Obstruction/congenital, Enteral Nutrition/methods, Female, Humans, Infant, Newborn, Intestinal Atresia/surgery, Male, Parenteral Nutrition/methods, Practice Patterns, Physicians'/statistics & numerical data, Surveys and Questionnaires, United Kingdom
Jager, Alexandra
68680471-2bba-4986-968a-0643109f858e
Turnbull, Joanne
cd1f8462-d698-4a90-af82-46c39536694b
Johnson, Mark
ce07b5dd-b12b-47df-a5df-cd3b9447c9ed
Hall, Nigel J.
6919e8af-3890-42c1-98a7-c110791957cf
18 March 2025
Jager, Alexandra
68680471-2bba-4986-968a-0643109f858e
Turnbull, Joanne
cd1f8462-d698-4a90-af82-46c39536694b
Johnson, Mark
ce07b5dd-b12b-47df-a5df-cd3b9447c9ed
Hall, Nigel J.
6919e8af-3890-42c1-98a7-c110791957cf
Jager, Alexandra, Turnbull, Joanne, Johnson, Mark and Hall, Nigel J.
(2025)
Exploring the current usage of and attitudes towards trans-anastomotic tube (TAT) feeding in infants born with duodenal atresia: a survey of practice in the UK.
BMJ Paediatrics Open, 9 (1).
(doi:10.1136/bmjpo-2024-003267).
Abstract
Background: despite evidence demonstrating clinical and cost benefits of transanastomotic tubes (TATs), following repair of congenital duodenal obstruction they are used in a minority of infants in the UK. Most infants are fed using parenteral nutrition (PN) (sometimes in combination with a TAT). This variation is unexplained by clinical or demographic factors. We aimed to understand why this is and the barriers to practice change.
Methods: UK-based clinicians (surgeons, neonatologists, dietitians and specialist nurses) completed an online mixed methods survey. Open-ended replies were summarised thematically. Data were analysed using descriptive and inferential statistics.
Results: 109 clinicians (24 neonatologists, 7 nurses, 3 dietitians, 75 surgeons) from all 25 UK neonatal surgical units completed the survey. 88% (n=96/109) stated TAT use was decided solely by surgeons, driven primarily by considerations of providing appropriate nutrition and risks; 36% of surgeons felt TATs should always be used where possible. Decisions about central venous catheters (CVCs) were made by neonatologists (28%, n=31/109), surgeons (17%, n=18/109), jointly (48%, n=52/109) or ‘other’ (7%, n=8/109). Neonatologists and surgeons prioritised providing appropriate nutrition and risks when deciding whether to use CVCs/PN; surgeons rated a lack of supporting research and TATs’ risks as key barriers to TAT usage. Costs and parents’ preferences had limited influence on TAT and PN usage.
Conclusions: increased TAT usage requires surgeons to be persuaded of TATs’ efficacy and safety, and neonatologist recognition that exclusive TAT feeding (ie, without CVCs/PN) can provide adequate nutrition. Further work is required to appreciate how best to achieve this.
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Accepted/In Press date: 6 March 2025
e-pub ahead of print date: 18 March 2025
Published date: 18 March 2025
Keywords:
Attitude of Health Personnel, Duodenal Obstruction/congenital, Enteral Nutrition/methods, Female, Humans, Infant, Newborn, Intestinal Atresia/surgery, Male, Parenteral Nutrition/methods, Practice Patterns, Physicians'/statistics & numerical data, Surveys and Questionnaires, United Kingdom
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Local EPrints ID: 499767
URI: http://eprints.soton.ac.uk/id/eprint/499767
PURE UUID: ae8608c0-6d54-43be-bc10-a476dc197200
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Date deposited: 03 Apr 2025 16:46
Last modified: 11 Sep 2025 03:03
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Author:
Alexandra Jager
Author:
Mark Johnson
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