title: Evaluation of parenteral nutrition-associated liver disease in infants with necrotizing enterocolitis before and after the implementation of feeding guidelines.
abstract: BACKGROUND
  In 2009, an intestinal rehabilitation team implemented feeding guidelines for infants following gastrointestinal surgery at our institution. The purpose of this study was to determine the effect of enteral feeding guidelines on the incidence of parenteral nutrition (PN)-associated liver disease (PNALD) in infants with surgically managed necrotizing enterocolitis (NEC).
  
  
  METHODS
  This retrospective study included infants treated during 18-month time periods before and after the implementation of feeding guidelines. PNALD diagnosis was based on serum direct bilirubin >2 mg/dL after ≥14 days of PN exposure.
  
  
  RESULTS
  Of the 140 infants identified, 64 were surgically managed and included in the analysis. The duration of PN and the time nil per os (NPO) were significantly reduced after guideline implementation from a median of 106 days to 65 days (P = .03) and from 29 days to 16 days (P = .02), respectively. The incidence of PNALD decreased from 73% before guideline implementation to 42% after guideline implementation (P = .01).
  
  
  CONCLUSIONS
  Implementation of feeding guidelines resulted in decreased time NPO and duration of PN support. Significantly fewer infants developed PNALD after guideline implementation. These data suggest that feeding guidelines may expedite the transition from PN to enteral nutrition and may improve outcomes.
authors.affiliation: Emma M. Tillman, Le Bonheur Children's Hospital, 50 N. Dunlap, Memphis, TN 38103, USA. Email: etillman@uthsc.edu.
authors.forename: Emma M
authors.initials: EM
authors.lastname: Tillman
authors.forename: Johanna L
authors.initials: JL
authors.lastname: Norman
authors.forename: Eunice Y
authors.initials: EY
authors.lastname: Huang
authors.forename: Linda F
authors.initials: LF
authors.lastname: Lazar
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Crill
mesh_terms: D004750:Enteral Nutrition; D020345:Enterocolitis, Necrotizing / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008099:Liver; D008107:Liver Diseases / Q000209:etiology / Q000517:prevention & control; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies
keywords: enteral nutrition; necrotizing enterocolitis; parenteral nutrition; short bowel syndrome