title: Improved nutrition delivery and nutrition status in critically ill children with heart disease.
abstract: BACKGROUND
  This initiative sought to improve nutrition delivery in critically ill children with heart disease admitted to the cardiac ICU (CICU) and neonates undergoing stage 1 palliation (S1P) for single-ventricle physiology through interdisciplinary team interventions. Specific goals were increased caloric and protein delivery for all patients and a more nourished state for infants with single ventricles at the time of discharge.
  
  
  METHODS
  We developed a nutrition flow sheet in the electronic health record to track whether daily nutrition goals were met. Interventions included nurses reporting daily whether caloric and protein goals were met, mandatory involvement of feeding specialists, and introduction of an enteral nutrition guideline. For infants undergoing S1P, weight-for-age z score (as an indicator for assessing malnutrition) was calculated at admission and discharge.
  
  
  RESULTS
  The percentage of patient days per month when daily caloric goals were met increased from 50.1% to 60.7%, and protein goals met increased from 51.6% to 72.7%. Hospital length of stay, need for ventilation, and mortality did not differ. Patients undergoing S1P demonstrated a statistically significant improvement in weight-for-age z score compared with the preintervention group (P = .003). Thirteen S1P patients were discharged undernourished in the preintervention group; 5 were severely undernourished. In the intervention group, 4 patients were discharged undernourished, and none were severely undernourished.
  
  
  CONCLUSIONS
  This initiative resulted in improved nutrition delivery for a heterogeneous population of cardiac patients in the CICU as well as significant improvements in weight gain and nourishment status at discharge in infants undergoing S1P.
authors: The Heart Institute at Children's Hospital Colorado, Department of Pediatrics, jonathan.kaufman@childrenscolorado.org.
authors: Jon
authors: J
authors: Kaufman
authors: The Heart Institute at Children's Hospital Colorado, Clinical Nutrition at Children's Hospital Colorado, and.
authors: Piyagarnt
authors: P
authors: Vichayavilas
authors: Clinical Informatics at Children's Hospital Colorado, Aurora, Colorado;
authors: Michael
authors: M
authors: Rannie
authors: The Heart Institute at Children's Hospital Colorado, School of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado; and.
authors: Christine
authors: C
authors: Peyton
authors: The Heart Institute at Children's Hospital Colorado, School of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado; and.
authors: Esther
authors: E
authors: Carpenter
authors: Clinical Nutrition at Children's Hospital Colorado, and.
authors: Danielle
authors: D
authors: Hull
authors: The Heart Institute at Children's Hospital Colorado, School of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado; and.
authors: Jennifer
authors: J
authors: Alpern
authors: The Heart Institute at Children's Hospital Colorado, Department of Pediatrics.
authors: Cindy
authors: C
authors: Barrett
authors: The Heart Institute at Children's Hospital Colorado, Department of Pediatrics.
authors: Eduardo M
authors: EM
authors: da Cruz
authors: Department of Emergency Medicine, Denver Health Hospital Authority, Denver, Colorado.
authors: Genie
authors: G
authors: Roosevelt
mesh_terms: D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy*; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D006331:Heart Diseases / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D007902:Length of Stay / Q000639:trends; D008297:Male; D009752:Nutritional Status; D010166:Palliative Care / Q000379:methods*; D010288:Parenteral Nutrition / Q000379:methods*; D015430:Weight Gain / Q000502:physiology*
keywords: cardiac surgery; cardiology; nutrition; pediatrics