A Cross-Sectional Study on NPO Status and Its Fluctuation Rate in Pediatric Patients Undergoing Elective Surgeries: A Survey Based on Interviews

Abstract

Background: Prolonged preoperative fasting in pediatric patients can cause hypoglycemia, dehydration, and increased perioperative stress, yet adherence to evidence-based nil per os (NPO) guidelines remains inconsistent. International recommendations advocate fasting durations tailored to intake type—2 hours for clear fluids, 4 hours for breast milk, 6 hours for light meals, and 8 hours for solids or high-fat meals—however, many institutions continue outdated, conservative practices. Objective: To evaluate adherence to ASA-recommended fasting durations among pediatric surgical patients, quantify deviations, and assess their distribution across age groups. Methods: A descriptive cross-sectional study was conducted at Mayo Hospital, Lahore, involving 210 pediatric patients aged 6 months–12 years undergoing elective surgery under general anesthesia. Participants were selected via simple random sampling. Data on intake type, prescribed fasting duration, and actual fasting time were collected via structured caregiver interviews. Statistical analysis used chi-square and descriptive measures in SPSS v26. Results: Only 8.6% of patients achieved exact adherence to guidelines, while 91.4% exhibited deviations, most commonly 2–3 hours longer than recommended. No significant association was found between age group and deviation (p=0.699). Conclusion: Excessive fasting is widespread across all pediatric age groups, indicating a need for updated institutional policies, improved scheduling, and caregiver education to align practice with evidence-based NPO guidelines.