Feedings are generally restarted between the third and fifth post-operative day depending on whether bowel surgery has been performed as part of the transplant. Babies may require feeding tube supplementation particularly when oral intake was poor prior to the transplant. Unless there are complications, the diet can be quickly advanced to age appropriate food supplemented in some cases with special liquid enteral feeds.
The resolution of postoperative ileus and implementation of oral feeding calls for vigilance in the monitoring of immunosuppressive medication levels as absorption of these drugs may increase significantly in the days following transplantation. Usually, the transition between intravenous and oral administration of medication takes place during this week unless other complications arise.
If infections occur in the early postoperative period, they are usually bacterial. Sources of infection include intra abdominal sites such as the bowel or biliary tract, particularly in children who have been transplanted for biliary atresia. Other common sites are intravenous catheter and arterial infusion sites.
Early and aggressive investigation and treatment are essential for the successful resolution of these infections. Careful physical examination, chest X-ray and abdominal ultrasound along with culture of blood, urine and wounds will usually uncover the source. Empirical treatment with antibiotics is often recommended when the source of the fever is undetermined. Antibiotics, which cover enterobacter and enterococci, are important in the early post transplant period. Yeast infections should always be suspected if a septic picture continues and there is no improvement with antibiotics. Children, who have been on pre transplant steroids, those with bile leaks or bowel perforations and those with arterial thrombosis have been shown to be at higher risk for the development of Candida infections.
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