is commonly initiated 24 hours after percutaneous endoscopic gastrostomy
(PEG) in children. Adult studies report safe refeeding
within 1 to 6 hours of PEG, and these findings have been cautiously applied to children. Comparative studies assessing early versus next-day refeeding
in children are currently lacking. This study evaluates feeding tolerance and complications following early versus next-day refeeding
This is a single-center, pre-post study. In June 2015 our clinical practice changed to begin refeeding
within 6 hours of PEG. Children receiving early refeeding
from December 2015 to August 2017 were included. A retrospective cohort from February 2013 to April 2015 was used for comparison.
Forty-six children received early refeeding
after PEG and 37 received next-day refeeding
. Gender distribution was similar in the 2 groups. Early refeeding
patients were slightly older (3.5 vs 2.2 years) and heavier (15.5 vs 11.5 kg) at PEG placement compared to next-day refeeding
patients. Early refeeding
patients experienced greater postprocedural nausea and/or vomiting (19% vs 8%, P
< 0.001) and leakage, irritation, and infection around the stoma (19% vs 0.0%, P
< 0.001). Compared to early refeeders, next-day refeeding
patients experienced higher occurrence of fever (35% vs 13%, P
= 0.021), longer nutritional disruption (24.6 vs 3.7 hours, P
< 0.001), and longer length of stay (51 vs 27 hours; P
< 0.001). One next-day refeeding
patient experienced peritonitis. One early refeeding
patient experienced cellulitis requiring hospitalization and a second experienced gastrostomy tube migration into the peritoneal cavity requiring removal.
Early refeeders experienced higher rates of postprocedural nausea or vomiting and irritation, leakage, or infection around the stoma; but experienced lower rates of postoperative fever. Early refeeding
resulted in reduced nutritional interruption and hospital length of stay.