15 NUTRITIONAL CARE FOR INFANTS WITH BILIARY ATRESIA AFTER KASAI HEPATOPORTOENTEROSTOMY: ORAL OR TUBE FEEDING?
L.A. Grutters1, H.J. Verkade1, J.B.F. Hulscher1, R.H.J. de Kleine2, T. Dijkstra1, J.L.M. Bruggink1
1Beatrix Children's Hospital, University Medical Centre Groningen, Groningen, Netherlands. 2University Medical Centre Groningen, Groningen, Netherlands

Abstract

Aim of the study. Infants with biliary atresia (BA) frequently have an impaired nutritional status at the moment of Kasai hepatoportoenterostomy (KPE), possibly exerting negative effects on short- and long-term outcome. We analysed perioperative nutritional status and growth of infants undergoing KPE.

Methods. All BA infants who underwent KPE in our centre from 2008-2017 were retrospectively included. We reported anthropometric measurements, including mid upper arm circumference (MUAC) and weight, and nutritional status at admission and one, four and eight weeks post-surgery. Throughout the study adequate nutrition was defined as 130 kcal/kg/day and 3.0 protein(g)/kg/day.

Main Results. We included 49 infants (14M/35F), mean 60 days (±17) of age at KPE. Upon admission, mean z-scores for weight and mid upper arm circumference (MUAC) were -0.56 (±1.18) and -1.94 (±0.74) (p=0.011). After KPE z-scores declined but reached preoperative values again at four weeks post-surgery (Figure). Up to eight weeks post-surgery, MUAC z-scores were lower than weight z-scores. At admission, all infants were fed with breast milk or standard formula. After KPE, all infants received diet formula (Heparon Junior®). At admission, one, four and eight weeks 21, 48, 61, 34% of infants met adequate feeding intake. One week post-surgery, 53% of infants was fed orally [breast/bottle] and 47% received tube feeding [nasogastric/parenteral], 27% and 68% resp. reached adequate nutrition (p=0.015).

Conclusions. Most BA infants are malnourished at the moment of KPE. MUAC reflects the state of (mal)nutrition more accurately than weight. During the early post-operative phase, a major fraction of infants, especially those regularly fed, do not obtain adequate nutritional intake. Therefore, aggressive perioperative nutritional care seems warranted.

 


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