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We investigated whether early enteral nutrition alone may be sufficient prophylaxis against stress-related gastrointestinal (GI) bleeding in mechanically ventilated patients. Prospective, double blind, randomized, placebo-controlled, exploratory study that included mechanically ventilated patients in medical ICUs of two academic hospitals. Intravenous pantoprazole and early enteral nutrition were compared to placebo and early enteral nutrition as stress-ulcer prophylaxis. The incidences of clinically significant and overt GI bleeding were compared in the two groups. 124 patients were enrolled in the study. After exclusion of 22 patients, 102 patients were included in analysis: 55 patients in the treatment group and 47 patients in the placebo group. Two patients (one from each group) showed signs of overt GI bleeding (overall incidence 1.96%), and both patients experienced a drop of >3 points in hematocrit in a 24-hour period indicating a clinically significant GI bleed. There was no statistical significant difference in the incidence of overt or significant GI bleeding between groups (p=0.99). We found no benefit when pantoprazole is added to early enteral nutrition in mechanically ventilated critically ill patients. The routine prescription of acid-suppressive therapy in critically ill patients who tolerate early enteral nutrition warrants further evaluation. •GI bleeding has low incidence in the critically ill mechanically ventilated patients.•Adding PPI to enteral nutrition may not offer an added prophylaxis against stress-related GI bleeding.•Our study supports the protective role of enteral nutrition in ICU.

PurposeDelayed enteral feeding (DEF) contributes to postoperative complications among children undergoing intestinal surgery. Various recent studies indicate the benefits of early enteral nutrition after intestinal surgery in adults. This systematic review and meta-analysis evaluates whether early enteral feeding (EEF) is beneficial in children who underwent intestinal anastomosis.MethodsMEDLINE, PubMed, the Cochrane Library, and Web of Science databases were searched for RCTs that addressed the effect of EEF in children (younger than 18 years old) undergoing intestinal anastomosis. EEF was defined as starting enteral feeding before the 3rd postoperative day. Studies were selected based on predetermined inclusion and exclusion criteria. A meta-analysis was performed using RevMan 5.3 to estimate odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs).ResultsFour RCT studies met the inclusion criteria, comprising 97 cases with EEF and 89 cases with DEF. Enteral feeding started significantly earlier in the EEF group compared to the DEF group (MD = − 2.80; 95% CI − 3.11 to − 2.49; p < 0.00001). Postoperative anastomotic leak rate was unchanged between EEF and DEF groups (OR = 0.86; 95% CI 0.17–4.46; p = 0.86). The EEF group had a shorter length of hospital stay (MD = − 3.38; 95% CI − 4.29 to − 2.48; p < 0.00001), earlier time to bowel movement return (MD = − 0.57; 95% CI − 0.79 to − 0.35; p < 0.00001), lower incidence of surgical infection (OR = 0.27; 95% CI 0.08–0.90; p = 0.03), and faster tolerance of full enteral feeding (MD = − 2.00; 95% CI − 3.01 to − 2.79; p < 0.00001). Incidence of fever (OR = 0.37; 95% CI 0.10–1.31; p = 0.12), emesis, and abdominal distention (OR = 0.63; 95% CI 0.13–3.16; p = 0.58) were not different between the two groups.ConclusionsEarly enteral feeding after intestinal anastomosis in children does not increase the risk of postoperative anastomotic leak, fever, emesis, and abdominal distention. However, early enteral feeding is beneficial as it promotes the return of bowel function, reduces the length of hospital stay and the incidence of surgical infection in comparison to delayed enteral feeding.

AimThe restoration of intestinal continuity after colostomy closure is a critical step and postoperative recovery is influenced by nutritional strategies. This study aimed to evaluate the safety and efficacy of early versus conventional feeding in children undergoing sigmoid colostomy closure on postoperative recovery parameters.Materials and MethodsA prospective randomized observational study was carried out at a tertiary care hospital between January 2022 and October 2025. Fifty children (<16 years) undergoing stoma closure were randomized into two groups: Group A (early feeding within 48 hours postoperatively) and Group B (conventional feeding after return of bowel function or on postoperative day 5). Demographic data, perioperative parameters, and postoperative outcomes including time to initiation of feeding, time to full feeds, bowel function recovery, complications, and hospital stay were analyzed using SPSS v24.0.ResultsOf the 50 patients (39 males, 11 females; mean age 1.1 years), 25 were allocated to each group. Feeding was initiated significantly earlier in Group A (mean 18.7 hours) compared with Group B (52.6 hours; p<0.001). Time to achieve full feeds was shorter in Group A (median 42.5 hours) versus Group B (72.5 hours; p<0.001). First bowel movement occurred earlier in Group A (mean 4.1 days) than Group B (5.9 days; p<0.01). Median hospital stay was reduced in Group A (4.5 days) compared with Group B (6 days; p<0.01). No anastomotic leaks or wound dehiscence were observed. Minor complications included transient vomiting and urinary tract infections, with no significant differences between the groups.ConclusionEarly enteral feeding after stoma closure in children with high anorectal malformation is safe, well tolerated, and associated with faster recovery and shorter hospital stays compared with conventional feeding.

Context: Elective intestinal anastomosis is a frequently used surgical procedure in pediatric surgery. Aims: This study aimed to compare postoperative complications and hospital stay in children who underwent ileostomy closure with early feeding in the 1st 24 h versus those in whom the oral route was initiated traditionally. Settings and Design: Observational, comparative, cross-sectional, ambispective, and single-center study that included pediatric patients who had undergone ileostomy closure from January 2017 to August 2019. Materials and Methods: Data were analyzed in SPSS. Statistical analysis was used: the variables were analyzed using the Chi-square test or Fisher's exact test when the former could not be applied. Results: They were divided into the following two groups: group 1 included patients who started the oral route early (n = 25) and Group 2 included patients who started the oral route late (n = 20). The average in-hospital stay for Group 1 was 5.48 days and that for Group 2 was 8.35 days. In Group 1, the oral route was started with a mean of 9.32 h and in Group 2 at 146.4 h. Those in Group 1 at 32.9 h presented their first evacuation and Group 2 at 131.45 h. Group 1 reached their normal diet on average at 79.96 h and Group 2 at 172.8 h. Conclusions: This comparison between early oral feeding and traditional oral feeding suggests that various benefits exist when enteral nutrition is initiated early after ileostomy closure in pediatric patients. The benefits and importance of initiating early oral feeding in adults have been reported, but there are few studies on pediatric populations

Guidelines for patients with severe traumatic brain injury (sTBI) published in 2007 recommend providing early nutrition after trauma. Early enteral nutrition (EN) started within 48 h post-injury reduces clinical malnutrition, prevents bacterial translocation from the gastrointestinal tract, and improves outcome in sTBI patients sustaining hypermetabolism and hypercatabolism. The aim of this study was to examine the effect of early EN support on survival rate, Glasgow Coma Scale (GCS) score, and clinical outcome of sTBI patients. Medical records of sTBI patients with GCS scores 4–8 were recruited from 18 hospitals in Taiwan, excluding patients with GCS scores ≤3. During 2002–2010, data from 145 EN patients receiving appropriate calories and nutrients within 48 h post-trauma were collected and compared with 152 non-EN controls matched for gender, age, body weight, initial GCS score, and operative status. The EN patients had a greater survival rate and GCS score on the 7th day in the intensive care unit (ICU), and a better outcome at 1 month post-injury. After adjusting for age, gender, initial GCS score, and recruitment period, the non-EN patients had a hazard ratio of 14.63 (95% CI 8.58–24.91) compared with EN patients. The GCS score during the first 7 ICU days was significantly improved among EN patients with GCS scores of 6–8 compared with EN patients with GCS scores of 4–5 and non-EN patients with GCS scores of 6–8. This finding demonstrates that EN within 48 h post-injury is associated with better survival, GCS recovery, and outcome among sTBI patients, particularly in those with a GCS score of 6–8.

BackgroundGastroschisis is the most common congenital abdominal wall defect. Due to the exposure of midgut to amniotic fluid, the recovery of bowel function is often delayed. This study aimed to identify the factors associated with the successful early enteral feeding in gastroschisis and to develop further guidelines of treatment.MethodsA retrospective cohort study of gastroschisis babies from January 2006 to December 2015 was done. Exclusion criteria were incomplete data and death. Successful early enteral feeding was defined when full feeding was achieved within 21 days of life.ResultsOne hundred and five gastroschisis patients were divided into a successful early-feeding group (n = 56, 53%) and a non-successful early-feeding group (n = 49, 46%). In multivariable analysis, significant factors for successful feeding clustered by primary treatment were female (RR = 1.38, P value < 0.001), gestational age > 36 weeks (RR = 1.23, P value < 0.001), age at surgery less than 10 h (RR = 1.15, P value < 0.001), postoperative extubation time < 4 days (RR = 1.39, P value < 0.001), and age when feeding started less than 10 days (RR = 35.69, P value < 0.001).ConclusionSeveral factors were found to be associated with successful early enteral feeding. The modifiable factors found in this study were surgery within 10 h, early postoperative extubation within 4 days, and feeding started before 10 days of life. These will guide the management of gastroschisis to achieve successful early enteral feeding.

Background Early enteral nutrition is recommended in cases of critical illness. It is unclear whether this recommendation is of most benefit to extremely ill patients. We aim to determine the association between illness severity and commencement of enteral feeding. Methods One hundred and eight critically ill patients were grouped as “less severe” and “more severe” for this cross-sectional, retrospective observational study. The cut off value was based on Acute Physiology and Chronic Health Evaluation II score 20. Patients who received enteral feeding within 48 h of medical intensive care unit (ICU) admission were considered early feeding cases otherwise they were assessed as late feeding cases. Feeding complications (gastric retention/vomiting/diarrhea/gastrointestinal bleeding), length of ICU stay, length of hospital stay, ventilator-associated pneumonia, hospital mortality, nutritional intake, serum albumin, serum prealbumin, nitrogen balance (NB), and 24-h urinary urea nitrogen data were collected over 21 days. Results There were no differences in measured outcomes between early and late feedings for less severely ill patients. Among more severely ill patients, however, the early feeding group showed improved serum albumin (p = 0.036) and prealbumin (p = 0.014) but worsened NB (p = 0.01), more feeding complications (p = 0.005), and prolonged ICU stays (p = 0.005) compared to their late feeding counterparts. Conclusions There is a significant association between severity of illness and timing of enteral feeding initiation. In more severe illness, early feeding was associated with improved nutritional outcomes, while late feeding was associated with reduced feeding complications and length of ICU stay. However, the feeding complications of more severely ill early feeders can be handled without significantly affecting nutritional intake and there is no eventual difference in length of hospital stay or mortality between groups. Consequently, early feeding shows to be a more beneficial nutritional intervention option than late feeding in patients with more severe illness.

After resective and reconstructive surgery in the gastrointestinal tract, oral feeding is traditionally avoided in order to minimize strain to the anastomoses and to reduce the inherent risks of the postoperatively impaired gastrointestinal motility. However, studies have given evidence that the small bowel recovers its ability to absorb nutrients almost immediately following surgery, even in the absence of peristalsis, and that early enteral feeding would preserve both the integrity of gut mucosa and its immunological function. The aim of this study was to investigate the impact of early enteral feeding on the postoperative course following oesophagectomy or oesophagogastrectomy, and reconstruction. Between May 1999 and November 2002, forty-four consecutive patients (thirty-eight males and six females; mean age 62, range 30–82) with oesophageal carcinoma (stages I–III), who had undergone radical resection and reconstruction, entered this study (early enteral feeding group; EEF). A historical group of forty-four patients (thirty-seven males and seven females; mean age 64, range 41–79; stages I–III) resected between January 1997 and March 1999 served as control (parenteral feeding group; PF). The duration of both postoperative stay in the Intensive Care Unit (ICU) and the total hospital stay, perioperative complications and the overall mortality were compared. Early enteral feeding was administered over the jejunal line of a Dobhoff tube. It started 6 h postoperatively at a rate of 10 ml/h for 6 h with stepwise increase until total enteral nutrition was achieved on day 6. In the controls oral enteral feeding was begun on day 7. If compared to the PF group, EEF patients recovered faster considering the duration of both stay in the ICU and in the hospital. There was a significant difference in the interval until the first bowel movements. No difference in overall 30 d mortality was identified. A poor nutritional status was a significant prognostic factor for an increased mortality. Early enteral feeding significantly reduces the duration of ICU treatment and total hospital stay in patients who undergo oesophagectomy or oesophagogastrectomy for oesophageal carcinoma. The mortality rate is not affected.

Management of burns is an often-neglected area in training from undergraduate to specialist level. There is, however, a high burden of injury that affects a largely vulnerable population, for example, children, the elderly and epileptics. This CPD article highlights that first aid should include cooling the burn with cool running tap water up to 3-hours post injury (Burnshield may be used if cool running water is not available); removal of all blisters facilitates accurate assessment of the burn size and depth; formulas exist for the resuscitation of acute burn injuries of more than 10% – 15% total body surface area and prophylactic antibiotics should not be administered to patients with acute burns as the prevention of infection should lie with good wound care (including good wound cleaning and the use of topical antimicrobial dressings). A standardised approach to pain management with an incremental pharmacological approach should be followed whilst considering other issues such as neuropathic pain, anxiety and depression.

Purpose Early enteral feeding within 24–48 h of intensive care unit admission is recommended for critically ill patients. This study aimed to determine if early enteral feeding could be safely implemented with purported benefits in patients with abdominal trauma. Methods A retrospective cohort study was performed that included 88 adult patients with abdominal trauma. Patients receiving enteral feeding within 72 h of surgical intensive care unit (SICU) admission (early-initiation group, n  = 28) were compared to those receiving enteral feeding later (delayed-initiation group, n  = 60). Results The two groups were comparable in demographic characteristics and injury severity. There were no differences in feeding intolerance (53.6 vs. 43.3 %, p  = 0.37) and mortality at 28 days (0 vs. 5 %, p  = 0.55) between the early-initiation group and the delayed-initiation group. However, patients in the early-initiation group had fewer infectious complications (17.9 vs. 40 %, p  = 0.04) and shorter length of stay in SICU and hospital ( p  < 0.01) than patients in the delayed-initiation group. Conclusions Early enteral feeding administered within 72 h of SICU admission was associated with improved clinical outcomes without risk of increasing feeding intolerance in patients with abdominal trauma. Our results support the implementation of early enteral feeding in abdominal trauma management.