Enteral feeding algorithm for infants with hypoplastic left heart syndrome poststage I palliation.
BACKGROUND
Infants with hypoplastic left heart syndrome (HLHS) experience a high incidence of growth failure in the postoperative period following stage I palliation. Because of an increased risk of necrotizing enterocolitis in this population, clinicians may be reluctant to initiate early enteral feedings. Published guidelines for initiating and advancing enteral feedings in this population are limited.


OBJECTIVE
To test the safety and efficacy of an enteral feeding algorithm in infants with HLHS following stage I palliation.


METHODS
Single-center, prospective case series with historical comparisons.


METHODS
Pediatric cardiovascular intensive care unit in tertiary care children's hospital.


METHODS
The study group consisted of consecutive patients > or =35 wks gestational age and weight > or =2 kg admitted to our cardiac intensive care unit over an 18-month period following stage I palliation of HLHS (n = 36). Excluded were nonsurvivors, patients supported on extracorporeal membrane oxygenation or those with a history of NEC or fetal intervention. These data were compared with a similar cohort of patients admitted to the cardiac intensive care unit over an 18-month period before the implementation of the feeding algorithm (n = 27).


METHODS
A feeding algorithm was implemented in the study group in the postoperative period for initiation and advancement of enteral nutrition.


RESULTS
The median duration of total parenteral nutrition was significantly higher in the control group (116 vs. 51 hrs; p = 0.03) compared with the study group. The median time to achieve recommended daily allowance of calories defined as 108 kcal/kg per day was significantly reduced in the study group (9 vs. 13 days; p = 0.01). Despite the rapid advancement of enteral feedings on the algorithm, there was no incidence of NEC in the study group compared with 11% in the control group.


CONCLUSIONS
The use of an enteral feeding algorithm is a safe and effective means of initiating and advancing enteral nutrition in infants with HLHS following stage I palliation.
Braudis
Nancy J
NJ
Department of Nursing, Cardiac Intensive Care Unit, Children's Hospital Boston, Boston, MA, USA. nancy.braudis@childrens.harvard.edu
Curley
Martha A Q
MA
Beaupre
Karen
K
Thomas
Kristi C
KC
Hardiman
Gina
G
Laussen
Peter
P
Gauvreau
Kimberlee
K
Thiagarajan
Ravi R
RR
D000367:Age Factors; D001034:Apgar Score; D019091:Critical Pathways; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D020345:Enterocolitis, Necrotizing / Q000209:etiology; D005260:Female; D005865:Gestational Age; D006776:Hospitals, Pediatric; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery / Q000628:therapy*; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D010288:Parenteral Nutrition; D011184:Postoperative Period; D011446:Prospective Studies