Z Wu, W Zhang, Z Cheng, S Chen, T Zuo, J Fu, B Wang

Abstract

Objectives: This study aimed to determine the efficacy of early enteral nutrition in the treatment of jaundice and improving the liver function, intestinal flora and nutritional status of children after portojejunal anastomosis (Kasai) towards reducing the incidence of cholangitis. Study Design: A case-control study. Place and Duration of Study: Shenzhen Children's Hospital from August 1st, 2020 to December 31st, 2021. Methods: A prospective randomised controlled study was performed in children diagnosed with biliary atresia who underwent the Kasai procedure. The patients were randomised to a control group that received total parenteral nutrition and an experimental group that received early enteral nutrition. The patients were followed up for 1 year and the liver function indices, intestinal flora, growth and nutritional status were analysed. The time to the first postoperative incidence of cholangitis, the number of cholangitis attacks and the survival rate of the autologous liver at one year were compared across the two groups. Results: At thirty and sixty days after the operation, the survival of patients in the experimental group was significantly higher than in the control group (P<0.05). At 7, 30 and 60 days after the operation, the levels of red blood cells, white blood cells and peripheral blood cells were significantly higher in the experimental group compared to the control group (P<0.05). At 30 and 60 days after the operation, the levels of total bilirubin and direct bilirubin were significantly lower in the experimental group compared to the control group (P<0.05). At 7, 30 and 60 days after the operation, the levels of aspartate aminotransferase, alanine aminotransferase and γ-glutamyltransferase, alkaline phosphatase and total bile acid were all lower in the experimental group compared to the control group (P<0.05). No significant differences in the numbers of Bifidobacterium, Lactobacillus, Enterococcus and Escherichia coli in the feces were observed between the 2 groups before the operation (P>0.05). Before recovery with oral feeding, the numbers of Bifidobacterium and Lactobacillus in the feces of the experimental group were higher than the control group. Also, the numbers of Enterococcus and Escherichia coli in the experimental group were lower than in the control group (P<0.05). Before recovery with oral feeding, the levels of fecal bacteria in the experimental group were significantly higher than the control group (P<0.05). The average times to the first postoperative incidence of cholangitis in the experimental group were longer than that in the control group. The average number of cholangitis incidents was significantly lower in the experimental group compared to the control group (P<0.05). Conclusions: Early enteral nutrition can improve the nutritional status and growth of children following the Kasai procedure that is conducive to postoperative recovery. It can also improve the gastrointestinal flora balance, reduce the number of postoperative cholangitis attacks and improve the survival rate of autologous liver. Our data are of particular significance to improving the management of children with biliary atresia.