63 TIME TO ENTERAL FEEDS AND USAGE OF PARENTERAL NUTRITION WITH TRANS-ANASTOMOTIC TUBES IN CONGENITAL DUODENAL ATRESIA AND STENOSIS
George Bethell1, Anna-May Long2, Marian Knight2, Nigel Hall1, On behalf of BAPS-CASS2
1University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom. 2National Perinatal Epidemiology Unit, Oxford, United Kingdom

Abstract

Aim To determine the relationship between trans-anastomotic tube (TAT) use following repair of duodenal atresia (DA) or stenosis (DS) and early outcomes.

Methods DA/DS cases were prospectively identified for one year from March 2016 at participating paediatric surgery centres using the BAPS-CASS system. Fisher’s exact, Chi square and Mann-Whitney U tests were used as appropriate. (Ethics ref: 12/SC/0416).

Results All 100 identified cases of DA/DS underwent surgical repair and 40 infants had a TAT placed. Group characteristics shown in table. In infants with a TAT enteral feeds were commenced earlier (2 vs 5 days, p<0.01), and there was lower central venous catheter (CVC) and parenteral nutrition (PN) use (77.5% v 96.7%, p=<0.01 and 75.0% vs 96.7%; p<0.01 respectively). Time to full enteral feeds (9.5 vs 13 days, p=0.08) and weight change from birth to 28 days (standard deviation score -1.06 vs -0.88, p=0.19) were similar for both groups. In total 123 CVCs were used in 89 infants and 40 TATs in 40 infants. Complications occurred in 21 (17.1%) CVCs and TAT related complications in 2 (5.0%) TATs.

Conclusion In DA/DS TAT placement is associated with earlier enteral feeding, lower requirement for PN and lower CVC usage. In this population, complications occurred in over 1 in 6 CVCs whereas TAT complications were minimal. Use of a TAT appeared to have no influence on post-operative weight gain.

Table

 

 

 

TAT(n=40)

No TAT(n=60)

p

 

Gestational age, weeks

36

36

0.74

 

Birthweight, grams

2413

2470

0.9

 

Age at surgery, days

2

3

0.74

 

Aneuploidy(%)

17(42.5)

19(31.7)

0.29

 

Cardiac abnormality(%)

25(62.5)

21(35.0)

<0.01

 

Type I atresia(%)

10(25.0)

29(48.3)

0.04

 

Type II atresia(%)

1(2.5)

4(6.7)

   

Type III atresia(%)

19(47.5)

17(28.3)

   

Duodenoduodenostomy repair(%)

31(77.5)

46(76.7)

1

 


Table – Group characteristics


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