Researchers studied whether giving children better nutrition before surgery for Hirschsprung disease (a bowel condition) could prevent dangerous infections afterward. They split 110 children into two groups: one received special nutritional support before surgery, while the other received standard care. Three months after surgery, only 7% of children who got the nutrition support developed serious infections, compared to 29% in the standard care group. This means that improving what children eat before surgery could significantly reduce a common and serious complication that happens after this type of operation.

The Quick Take

  • What they studied: Does giving children better nutrition before bowel surgery reduce dangerous infections that happen after the operation?
  • Who participated: 110 children with Hirschsprung disease (a condition where part of the bowel doesn’t work properly) who needed surgery, split equally between two groups at seven major hospitals in China
  • Key finding: Children who received special nutrition support before surgery had a 7% infection rate afterward, compared to 29% in children who received regular care—a difference of 22 percentage points
  • What it means for you: If your child needs this surgery, asking about preoperative nutrition support may significantly lower their risk of serious complications. However, this research was done in China, so talk with your child’s doctor about whether these findings apply to your situation.

The Research Details

This was a randomized controlled trial, which is one of the strongest types of medical research. Researchers enrolled 110 children who needed pull-through surgery (a procedure to fix Hirschsprung disease by removing the damaged part of the bowel and connecting the healthy parts). The children were randomly assigned to two equal groups: 55 received special nutritional support before surgery, and 55 received standard medical care. The study took place across seven major hospitals in China between January 2021 and October 2022. Doctors and families knew which group each child was in, but the researchers used a computer system to randomly decide the assignments to reduce bias.

The nutritional support group received special feeding plans designed to improve their nutrition before surgery. Researchers then tracked both groups for three months after surgery to see how many children developed HAEC (Hirschsprung-associated enterocolitis), which is a serious infection of the bowel that can happen after this type of surgery.

This study design is important because it allows researchers to directly compare what happens when children get nutrition support versus when they don’t. By randomly assigning children to groups, researchers can be more confident that any differences in infection rates are due to the nutrition support and not other factors. The fact that this was done across seven hospitals makes the results more reliable than if it had been done at just one location.

This is a high-quality study because it was a randomized controlled trial published in a top scientific journal (Nature Communications). The study was properly registered before it started, which means the researchers committed to their plan in advance. The sample size of 110 children is reasonable for this type of research. However, the study was open-label, meaning doctors and families knew which group children were in, which could potentially influence how they were treated or what they reported. The study was conducted in China, so results may vary in other countries with different healthcare systems.

What the Results Show

The main finding was striking: children who received nutritional support before surgery had a much lower rate of serious infections after surgery. In the nutrition support group, only 4 out of 55 children (7.27%) developed the dangerous infection called HAEC within three months of surgery. In contrast, 16 out of 55 children (29.09%) in the standard care group developed this infection. This means the nutrition support group had 22 percentage points fewer infections.

Statistically, this difference was very unlikely to happen by chance (p = 0.003, which means there’s less than a 0.3% probability this happened randomly). The researchers calculated that the nutrition support reduced the absolute risk of infection by 21.82%, with a confidence interval of -35.64% to -7.99%. In simpler terms, if 100 children received this nutrition support instead of standard care, we would expect about 22 fewer cases of serious infection.

No harmful side effects were reported in either group, meaning the nutrition support was safe. This is important because it shows that trying to improve nutrition before surgery doesn’t create new problems.

While the abstract doesn’t detail other outcomes, the fact that no adverse events occurred in either group is significant. This suggests that the special nutrition support was well-tolerated and didn’t cause any unexpected complications. The study focused specifically on infections at three months after surgery, which is the critical period when these complications typically develop.

Hirschsprung disease often leaves children malnourished before surgery because their bowel doesn’t work properly. Previous research has shown that malnutrition can weaken the immune system and slow healing after surgery. This study is one of the first to directly test whether fixing the malnutrition before surgery can prevent complications. The results support the idea that nutrition matters significantly for surgical outcomes in children with this condition.

This study was conducted only in China, so the results may not apply exactly the same way in other countries with different healthcare systems or populations. The study was open-label, meaning doctors and families knew which group children were in, which could potentially influence treatment decisions or how symptoms were reported. The study only followed children for three months after surgery, so we don’t know if the benefits continue longer than that. Finally, the study was relatively small (110 children), so larger studies would help confirm these findings.

The Bottom Line

If your child has been diagnosed with Hirschsprung disease and needs surgery, discuss preoperative nutritional support with your surgical team. The evidence suggests this approach may significantly reduce the risk of serious post-surgery infections. Ask your doctor about what type of nutritional support might be appropriate for your child. This recommendation has moderate to strong evidence supporting it based on this study, though more research in different populations would strengthen the evidence.

This research is most relevant for families with children who have Hirschsprung disease and need surgery. It’s also important for pediatric surgeons and gastroenterologists who care for these children. If your child has this condition, this information could help you make better decisions about preoperative care. This doesn’t apply to children without Hirschsprung disease or to adults, as the study was specific to children with this condition.

The benefit appears within the first three months after surgery, which is when serious infections are most likely to develop. You might start seeing the benefits of improved nutrition within weeks of beginning the nutritional support, though the most important outcome (preventing post-surgery infections) would be measured in the months following the operation.

Want to Apply This Research?

  • Track your child’s nutritional intake before surgery by logging daily calories, protein, and key nutrients (iron, zinc, vitamin C) that support healing. Record any symptoms or side effects from the nutritional support plan.
  • Work with your child’s doctor to implement a personalized pre-surgery nutrition plan. This might include high-protein foods, vitamin supplements, or special medical nutrition drinks. Set reminders to ensure consistent daily nutrition intake in the weeks before surgery.
  • Monitor your child’s weight and energy levels weekly before surgery. After surgery, track any signs of infection (fever, abdominal pain, diarrhea) and report them immediately to your medical team. Keep detailed records to share with your healthcare providers at follow-up appointments.

This research is specific to children with Hirschsprung disease undergoing pull-through surgery. These findings should not be applied to other conditions or populations without consulting a healthcare provider. Always discuss any nutritional interventions or changes to medical care with your child’s doctor before implementation. This summary is for educational purposes and does not replace professional medical advice. Individual results may vary based on factors not studied here, including age, overall health status, and healthcare setting. If your child has Hirschsprung disease, work with your surgical team to determine the most appropriate preoperative care plan for your specific situation.