Analysis of factors affecting postoperative feeding intolerance in neonates following intestinal surgery

BACKGROUND: Postoperative nutritional support is critical for neonatal recovery; however, this vulnerable population frequently experiences feeding intolerance during the postoperative period. A comprehensive analysis of the neonatal perioperative period is therefore essential to identify risk factors associated with postoperative feeding intolerance. OBJECTIVE: This study aimed to describe perioperative data in neonates and identify risk factors for postoperative feeding intolerance. METHODS​​: A retrospective analysis was performed on 694 neonates who received enteral nutrition (EN) following intestinal surgery at Guangdong Women and Children Hospital from August 2013 to December 2023. Based on EN tolerance, patients were categorized into an EN-tolerant group (n = 610) and an EN-intolerant group (n = 84). The groups were compared in terms of basic information (gender, age), birth-related factors (delivery method, full term or not, birth weight, birth asphyxia or not), surgery-related factors (surgical anatomical position, surgical level, operation method, fistulization or not, surgical duration, intraoperative blood transfusion or not), and postoperative management and nutritional support (postoperative indwelling gastric tube or not, feeding type, proton pump inhibitor or not, postoperative fasting time, hemoglobin levels). Logistic regression analysis was employed to identify factors influencing postoperative enteral nutrition intolerance. RESULTS​​: Postoperative feeding intolerance was observed in 12.1% of neonates. Full-term was identified as a protective factor against postoperative feeding intolerance (OR = 0.059, P < 0.01, 95%CI: 0.025–0.140). Risk factors included intraoperative blood transfusion (OR = 3.396, P < 0.01, 95%CI: 1.870–6.168) and postoperative indwelling gastric tube (OR = 9.640, P < 0.01, 95%CI: 5.096–18.238). CONCLUSION​​: Healthcare providers should closely monitor preterm infants, those with intraoperative blood transfusion, and those who receive postoperative indwelling gastric tubes for signs of feeding intolerance. Timely interventions are necessary to mitigate its incidence. TRIAL REGISTRATION: This study was prospectively registered on the China Clinical Trial Registry (ChiCTR2300074589) on 10 August 2023.