Early vs. delayed feeding after pediatric gastrointestinal surgery: a systematic review and meta-analysis

Abstract

Background: The adoption of early feeding after pediatric gastrointestinal surgery remains inconsistent due to concerns regarding anastomotic safety. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted comparing early enteral feeding (initiation within 48 h) with delayed feeding in patients < 18 years undergoing intestinal anastomosis or stoma reversal. Results: Eight trials comprising 704 patients (323 early feeding, 381 delayed) were included across neonatal and pediatric elective surgical populations. Early feeding significantly shortened hospital length of stay (mean difference − 3.53 days; 95% CI − 4.35 to − 2.71) and reduced time to full feeds (mean difference − 3.15 days; 95% CI − 3.89 to − 2.40). There was no significant difference in anastomotic leakage (log risk ratio − 0.36; 95% CI − 1.23 to 0.51; I²=0%) or postoperative vomiting (log risk ratio − 0.02; 95% CI − 0.41 to 0.38). Early feeding was also associated with fewer wound infections (log risk ratio − 0.85; 95% CI − 1.48 to − 0.22). Conclusions: Overall, early enteral feeding after pediatric gastrointestinal surgery appears safe and confers clinically meaningful benefits by accelerating nutritional recovery, reducing infectious complications, and shortening hospitalization, supporting its incorporation into pediatric postoperative care pathways.