title: Implementation of feeding guidelines in infants at risk of intestinal failure.
abstract: OBJECTIVE
  To implement feeding guidelines to reduce advancement time and the incidence of parenteral nutrition-associated liver disease (PNALD) among intestinal surgical infants requiring parenteral nutrition (PN).
  
  
  METHODS
  Feeding guidelines with higher initial enteral nutrition (EN) volume and specific advancement criteria were implemented for surgical infants aged <6 months. Preimplementation and postimplementation outcomes were compared.
  
  
  RESULTS
  There were 57 preimplementation and 33 postimplementation infants. The initial EN volume improved from 10 to 20 ml kg(-1) day(-1) (P<0.001). Time to reach 50% of goal calories from EN decreased by a median of 6 days (P=0.012) without a change in necrotizing enterocolitis incidence after resuming feeding. PNALD incidence decreased from 70% to 48% (P=0.046), and median peak direct bilirubin (DB) decreased from 5.6 to 2.3 mg dl(-1) (P=0.011).
  
  
  CONCLUSIONS
  Feeding guideline implementation with higher initial feeding volume was well tolerated and resulted in faster achievement of 50% goal EN calories. PNALD incidence and peak DB were reduced.
authors: Department of Pediatric Gastroenterology, Johns Hopkins Children's Center, Baltimore, MD, USA.
authors: D R
authors: DR
authors: Shores
authors: Department of Pediatric Neonatology, Johns Hopkins Children's Center, Baltimore, MD, USA.
authors: J E
authors: JE
authors: Bullard
authors: Department of Pediatric Neonatology, Johns Hopkins Children's Center, Baltimore, MD, USA.
authors: S W
authors: SW
authors: Aucott
authors: Department of General Pediatric Surgery, Johns Hopkins Children's Center, Baltimore, MD, USA.
authors: F D
authors: FD
authors: Stewart
authors: Department of Pediatric Nutrition, Johns Hopkins Children's Center, Baltimore, MD, USA.
authors: C
authors: C
authors: Haney
authors: Department of Pediatric Nutrition, Johns Hopkins Children's Center, Baltimore, MD, USA.
authors: H
authors: H
authors: Tymann
authors: Department of Pediatrics, Johns Hopkins Children's Center, Baltimore, MD, USA.
authors: M R
authors: MR
authors: Miller
authors: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: B A S
authors: BA
authors: Nonyane
authors: Department of Pediatric Gastroenterology, Johns Hopkins Children's Center, Baltimore, MD, USA.
authors: K B
authors: KB
authors: Schwarz
mesh_terms: D000046:Academic Medical Centers; D004065:Digestive System Abnormalities / Q000175:diagnosis* / Q000601:surgery*; D004750:Enteral Nutrition / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000379:methods / Q000592:standards; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008107:Liver Diseases / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D044623:Nutrition Therapy / Q000379:methods / Q000592:standards; D009751:Nutritional Requirements; D011182:Postoperative Care / Q000379:methods; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D015430:Weight Gain / Q000502:physiology