Hostname: page-component-848d4c4894-xfwgj Total loading time: 0 Render date: 2024-06-19T22:58:10.587Z Has data issue: false hasContentIssue false

The association between feeding protocol compliance and weight gain following high-risk neonatal cardiac surgery

Published online by Cambridge University Press:  24 May 2019

Jamie M. Furlong-Dillard*
Affiliation:
Division of Critical Care, Department of Pediatrics, University of Louisville, Norton Children’s Hospital, Louisville, KY, USA
Benjamin J. Miller
Affiliation:
Division of Critical Care, Department of Pediatrics, University of Utah, Primary Children’s Hospital, Salt Lake City, UT, USA
Kathy A. Sward
Affiliation:
Division of Critical Care, Department of Pediatrics, University of Utah, Primary Children’s Hospital, Salt Lake City, UT, USA
Alaina I. Neary
Affiliation:
Division of Speech Language Pathology, Department of Pediatrics, Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City, UT, USA
Trudy L. Hardin-Reynolds
Affiliation:
Division of Pediatric Critical Care, Department of Pediatrics, Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City, UT, USA
Grace Jeffers
Affiliation:
Division of Pediatric Critical Care, Department of Pediatrics, Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City, UT, USA
Bonnie A. Clay
Affiliation:
Division of Cardiothoracic Surgery, Department of Surgery, Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City, UT, USA
Dongngan T. Truong
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
Thomas A. Miller
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
Courtney E. Jones
Affiliation:
Division of Speech Language Pathology, Department of Pediatrics, Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City, UT, USA
Linda M. Lambert
Affiliation:
Division of Cardiothoracic Surgery, Department of Surgery, Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City, UT, USA
David K. Bailly
Affiliation:
Division of Critical Care, Department of Pediatrics, University of Utah, Primary Children’s Hospital, Salt Lake City, UT, USA
*
Author for correspondence: Jamie M. Furlong-Dillard, Division of Critical Care, Department of Pediatrics, University of Louisville, Norton Children’s Hospital, DO 571 S Floyd St, Suite 332 Louisville, KY 40202, USA. Tel: 678-294-0735; Fax: 502-852-3998; E-mail: Jamie.Furlong-Dillard@louisville.edu

Abstract

Background:

Children with congenital heart disease are at high risk for malnutrition. Standardisation of feeding protocols has shown promise in decreasing some of this risk. With little standardisation between institutions’ feeding protocols and no understanding of protocol adherence, it is important to analyse the efficacy of individual aspects of the protocols.

Methods:

Adherence to and deviation from a feeding protocol in high-risk congenital heart disease patients between December 2015 and March 2017 were analysed. Associations between adherence to and deviation from the protocol and clinical outcomes were also assessed. The primary outcome was change in weight-for-age z score between time intervals.

Results:

Increased adherence to and decreased deviation from individual instructions of a feeding protocol improves patients change in weight-for-age z score between birth and hospital discharge (p = 0.031). Secondary outcomes such as markers of clinical severity and nutritional delivery were not statistically different between groups with high or low adherence or deviation rates.

Conclusions:

High-risk feeding protocol adherence and fewer deviations are associated with weight gain independent of their influence on nutritional delivery and caloric intake. Future studies assessing the efficacy of feeding protocols should include the measures of adherence and deviations that are not merely limited to caloric delivery and illness severity.

Type
Original Article
Copyright
© Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Jenkins, E. Feeding protocols for neonates with hypoplastic left heart syndrome. AACN Adv Crit Care 2015; 26: 215221.CrossRefGoogle ScholarPubMed
Wang, KS, Ford, HR, Upperman, JS. Metabolic response to stress in the neonate who has surgery. Neoreviews 2006; 7: 410418.CrossRefGoogle Scholar
Owens, JL, Musa, N. Nutrition support after neonatal cardiac surgery. Nutr Clin Pract 2009; 24: 242249.CrossRefGoogle ScholarPubMed
Wong, JJ, Cheifetz, IM, Ong, C, et al. Nutrition Support for children undergoing congenital heart surgeries: a narrative review. World J Pediatr Congenit Heart Surg 2015; 3: 443454.CrossRefGoogle Scholar
Anderson, JB, Beekman, RH III Border, WL, et al. Lower weight-for-age z score adversely affects hospital length of stay after the bidirectional Glenn procedure in 100 infants with a single ventricle. J Thorac Cardiovasc Surg 2009; 138: 397404.CrossRefGoogle Scholar
Kelleher, DK, Laussen, P, Teixeira-Pinto, A, et al. Growth and correlates of nutritional status among infants with hypoplastic left heart syndrome (HLHS) after stage 1 Norwood procedure. Nutrition 2006; 22: 237244.CrossRefGoogle ScholarPubMed
Schwalbe-Terilli, CR, Hartman, DH, Nagle, ML, et al. Enteral feeding and caloric intake in neonates after cardiac surgery. Am J Crit Care 2009; 18: 5257.CrossRefGoogle ScholarPubMed
Ross, F, Latham, G, Joffe, D, et al. Preoperative malnutrition is associated with increased mortality and adverse outcomes after paediatric cardiac surgery. Cardiol Young 2017; 27: 17161725.CrossRefGoogle ScholarPubMed
Eskedal, LT, Hagemo, PS, Seem, E. Impaired weight gain predicts risk of late death after surgery for congenital heart defects. Arch Dis Child 2008; 93: 495501.CrossRefGoogle ScholarPubMed
Goldberg, CS, Lu, M, Sleeper, LA, et al. Pediatric heart network I. Factors associated with neurodevelopment for children with single ventricle lesions. J Pediatr 2014; 165: 490496.CrossRefGoogle ScholarPubMed
Braudis, NJ, Curley, MA, Beaupre, K, et al. Enteral feeding algorithm for infants with hypoplastic left heart syndrome poststage I palliation. Pediatr Crit Care Med 2009; 10: 460466.CrossRefGoogle ScholarPubMed
del Castillo, SL, McCulley, ME, Khemani, RG, et al. Reducing the incidence of necrotizing enterocolitis in neonates with hypoplastic left heart syndrome with the introduction of an enteral feed protocol. Pediatr Crit Care Med 2010; 11: 373377.Google ScholarPubMed
Mehta, NM, Bechard, LJ, Cahill, N, et al. Nutritional practices and their relationship to clinical outcomes in critically ill children—an international multicenter cohort study*. Crit Care Med 2012; 40: 22042211.CrossRefGoogle ScholarPubMed
Slicker, J, Hehir, DA, Horsley, M, et al. Nutrition algorithms for infants with hypoplastic left heart syndrome; birth through the first interstage period. Congenital Heart Dis 2013; 8: 89102.CrossRefGoogle ScholarPubMed
Hamilton, S, McAleer, DM, Ariagno, K, et al. A stepwise enteral nutrition algorithm for critically ill children helps achieve nutrient delivery goals. Pediatr Crit Care Med 2014; 15: 583589.CrossRefGoogle ScholarPubMed
Petrillo-Albarano, T, Pettignano, R, Asfaw, M, et al. Use of a feeding protocol to improve nutritional support through early, aggressive, enteral nutrition in the pediatric intensive care unit. Pediatr Crit Care Med 2006; 7: 340344.CrossRefGoogle ScholarPubMed
Meyer, R, Harrison, S, Sargent, S, et al. The impact of enteral feeding protocols on nutritional support in critically ill children. J Human Nutr Diet 2009; 22: 428436.CrossRefGoogle ScholarPubMed
Toms, R, Jackson, KW, Dabal, RJ, et al. Preoperative trophic feeds in neonates with hypoplastic left heart syndrome. Congenit Heart Dis 2015; 10: 3642.CrossRefGoogle ScholarPubMed
Yoshimura, S, Miyazu, M, Yoshizawa, S, et al. Efficacy of an enteral feeding protocol for providing nutritional support after paediatric cardiac surgery. Anaesth Intensive Care 2015; 43: 587593.CrossRefGoogle ScholarPubMed
Anderson, JB, Iyer, SB, Schidlow, DN, et al. Variation in growth of infants with a single ventricle. J Pediatr 2012; 161: 1621.CrossRefGoogle ScholarPubMed
Tronick, E, Lester, BM. Grandchild of the NBAS: the NICU Network Neurobehavioral Scale (NNNS). A review of the research using the NNNS. J Child Adolesc Psychiatr Nursing 2013; 26: 193203.CrossRefGoogle ScholarPubMed
Neu, J. Necrotizing enterocolitis: the search for a unifying pathogenic theory leading to prevention. Pediatr Clin North Am 1996; 43: 409432.CrossRefGoogle ScholarPubMed
Hehir, DA, Cooper, DS, Walters, EM, et al. Feeding, growth, nutrition, and optimal interstage surveillance for infants with hypoplastic left heart syndrome. Cardiol Young 2011; 21: 5964.CrossRefGoogle ScholarPubMed
Rice, TW, Mogan, S, Hays, MA, et al. A randomized trial of initial trophic versus full-energy enteral nutrition in mechanically ventilated patients with acute respiratory failure. Crit Care Med 2011; 39: 967974.CrossRefGoogle ScholarPubMed
Supplementary material: Image

Furlong-Dillard et al. supplementary material

Furlong-Dillard et al. supplementary material 1

Download Furlong-Dillard et al. supplementary material(Image)
Image 514.2 KB
Supplementary material: Image

Furlong-Dillard et al. supplementary material

Furlong-Dillard et al. supplementary material 2

Download Furlong-Dillard et al. supplementary material(Image)
Image 885.6 KB
Supplementary material: Image

Furlong-Dillard et al. supplementary material

Furlong-Dillard et al. supplementary material 3

Download Furlong-Dillard et al. supplementary material(Image)
Image 691.1 KB