Ad libitum feeding decreases hospital stay for neonates after pyloromyotomy

Purpose: The optimal feeding regimen for neonates after pyloromyotomy for hypertrophic pyloric stenosis (HPS) remains controversial. This study sought to compare ad libitum feeding to a Conventional feeding regimen with regard to time to full diet, length of hospital stay, and readmission rates. Methods: A 6-month review of 36 consecutive patients who underwent pyloromyotomy for HPS was undertaken. Patients were fed in 1 of 2 ways according to specific surgeon preference. Conventional Regimen patients (n = 19) were kept nothing by mouth (NPO) for 6 hours after surgery and incrementally advanced to full feedings. ad libitum (n = 17) patients were kept NPO until fully reversed from anesthesia and then given full strength formula or breast milk. Discharge was considered when 2 feedings of 60 mL were tolerated. Results: Twenty-eight males and 8 females with a mean age of 5.0 +/- 1.7 (SD) weeks, gestational age of 39 +/- 2.1 weeks, weight of 4.0 +/- 0.9 kg, and operating time of 56 +/- 12 minutes were studied. The interval from operating room to full diet was significantly less with ad libitum feeding than on the conventional regimen (20.3 +/- 5.0 v. 25.4 +/- 8.3 hours, P < .05). The Ad Libitum group also had a significantly decreased length of hospital stay (28.5 +/- 8.9 hours v, 35.8 +/- 11 hours; P < .05). There were no readmissions in either group. Conclusions: Ad libitum feedings decrease time to full diet and discharge without an increase in readmission rates. The estimated potential savings per patient using ad libitum feedings were $392.00. Thus, the use of ad libitum feedings after pyloromyotomy for HPS appears indicated.