Study Finds Prolonged Fasting Common Among Infants Before Anesthesia

Most children - including astir 80% of infants - spell without clear liquids earlier room for astatine slightest doubly arsenic agelong arsenic guidelines recommend, according to an study of information connected much than 70,000 children presented astatine nan ANESTHESIOLOGY® 2025 yearly meeting.

Healthy infants and children whitethorn safely portion clear liquids, including water, consequence juices without pulp and carbohydrate-containing beverages, until 2 hours earlier receiving anesthesia, according to guidelines from nan American Society of Anesthesiologists (ASA). The guidelines urge that children not portion thing wrong 2 hours earlier nan process to trim nan consequence of liquid entering nan lungs, which could origin choking aliases pneumonia. However, fasting longer tin beryllium harmful because it whitethorn origin dehydration, arsenic good arsenic unhealthy changes successful humor sweetener and different chemicals successful nan body.

Prolonged fasting from clear liquids of 4 hours aliases longer tin beryllium uncomfortable and summation thirst, anxiety, pain, nausea and vomiting. It tin beryllium harmful too. Children and infants are particularly susceptible to dehydration and calorie loss, which whitethorn heighten accent and slow betterment from surgery."

Alexander Nagrebetsky, M.D., M.Sc., elder writer of nan study and anesthesiologist and intensivist astatine Massachusetts General Hospital, Boston and adjunct professor astatine Harvard Medical School, Cambridge, Massachusetts

Researchers reviewed records from 71,835 children, aged 17 aliases younger (3,771 of whom were infants younger than 1 twelvemonth old), who had elective room astatine 1 of 12 U.S. hospitals betwixt 2016 and 2024. In nan study, prolonged fasting was defined arsenic fasting from clear liquids for 4 hours (or longer) earlier surgery, which is 2 times longer (or more) than guidelines recommend.

Overall, nan proportionality of children who fasted from clear liquids for astatine slightest 2 times longer than recommended earlier room decreased from 84.3% successful 2016 to 70.2% successful 2024, but accrued successful infants, from 75.9% successful 2016 to 79.6% successful 2024.

The median magnitude of clip each children fasted from clear liquids decreased wide from 10.9 hours successful 2016 to 8.7 hours successful 2024. However, location was nary important betterment successful infants, who fasted a median of 6.7 hours successful 2016 and 6.3 hours successful 2024. In 2024 alone, nan median long of clear liquid fasting was 3 times longer than nan proposal successful infants and 4 times longer successful each children.

While nan study didn't reside why parents and wellness attraction professionals withheld clear liquids from children for longer than recommended, location are apt respective reasons: parents and physicians whitethorn beryllium pursuing outdated practices of prolonged fasting (e.g., thing to portion aft midnight); deficiency of consciousness of ASA fasting guidelines that statement "efforts should beryllium made to let clear liquids successful patient children arsenic adjacent to 2 hours earlier nan process arsenic possible;" and a deficiency of knowing that prolonged fasting tin summation complications and negatively effect recovery.

Perioperative squad members should promote patients to portion h2o and liquids pinch sweetener for up to 2 hours earlier nan process erstwhile appropriate, said Dr. Nagrebetsky. Parents should advocator for their children and inquire their anesthesiologist astir existent recommendations for clear liquids earlier nan procedure, he said.

"The study confirmed our presumption that non-adherence to ASA fasting guidelines is communal successful nan U.S.," said Ethan Lowder, B.A., lead study writer and a student astatine Harvard Medical School. "Drinking sugar-containing clear liquids specified arsenic juices aliases those pinch electrolytes provides h2o and calories that children's bodies request for normal functioning, including dealing pinch nan accent of room and recovery."