Nutrition intervention in pediatric patients with thermal injuries who require laparotomy

Increased intra-abdominal pressure is a complication of thermal injuries th at is most commonly noted during burn shock or sepsis. Severely elevated in tra-abdominal pressure requires surgical treatment by laparotomy to avert c ardiac, respiratory, and renal compromise. The purpose of this retrospectiv e study was to examine the manipulation of the nutrition program and outcom es in response to such a procedure. Open laparotomy for increased intra-abd ominal pressure was necessary for 6 patients admitted to a pediatric burn f acility from March 1993 to April 1999. One patient was excluded from the re view because he died 2 days after the burn injury (1 day after the laparoto my) and nutrition intervention was not initiated. Four of the five remainin g patients received parenteral nutrition within 48 hours of surgery One pat ient did not receive parenteral nutrition because the enteral regimen was a t the goal by 5 days after the laparotomy. Trophic enteral feedings were in itiated in all 5 patients within 48 hours of the operations. Tube feedings were gradually increased and the parenteral nutrition rate was decreased in accordance with gastrointestinal tolerance (abdominal girth, bowel motilit y). Enteral nutrition was started before abdomen closure in all of the pati ents. No mechanical, infectious, or mortality-related complications related to the initiation of enteral nutrition after open laparotomies were noted. Surgical intervention by open laparotomy interrupts the postburn nutrition regimen but does not preclude the safe postoperative delivery and advancem ent of enteral feedings.