title: Standardization of Feeding Advancement After Neonatal Gastrointestinal Surgery: Does It Improve Outcomes?
abstract: BACKGROUND
  Postabdominal intestinal surgery (PAIS) infants pose many complex management issues. Utilization of feeding guidelines has been shown to improve outcomes in preterm and low-birth-weight infants. We propose that standardization of feeding for PAIS infants is safe.
  
  
  METHODS
  We identified 163 PAIS infants: 93 prior to and 70 after implementation of a feeding guideline. The primary outcome was time to full enteral nutrition (EN). A propensity score-matched analysis was performed.
  
  
  RESULTS
  The preimplementation and postimplementation PAIS infants were similar at baseline. No significant differences were seen in matched groups for time to full EN, parenteral nutrition days, or time to discharge, but cholestasis was less severe in the postimplementation group and breast milk use increased. Good compliance (67%) to daily guideline use was achieved during the initial 2 years.
  
  
  CONCLUSIONS
  Utilization of a feeding guideline is safe and standardizes care within an institution, improving compliance to evidence-based practices and outcomes.
authors.affiliation: 1 Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee, USA.
authors.forename: Kate B
authors.initials: KB
authors.lastname: Savoie
authors.affiliation: 1 Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee, USA.
authors.forename: Marielena
authors.initials: M
authors.lastname: Bachier-Rodriguez
authors.affiliation: 2 Children's Foundation Research Institute, Departments of Pediatrics & Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Tamekia L
authors.initials: TL
authors.lastname: Jones
authors.affiliation: 1 Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Jeffreys
authors.affiliation: 3 Dietetics and Nutrition, Le Bonheur Children's Hospital, Memphis, Tennessee, USA.
authors.forename: Dita
authors.initials: D
authors.lastname: Papraniku
authors.affiliation: 4 Division of Pediatric Gastroenterology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee, USA.
authors.forename: Wednesday Marie A
authors.initials: WMA
authors.lastname: Sevilla
authors.affiliation: 5 Department of Clinical Pharmacy, Indiana University Health, Riley Hospital for Children, Indianapolis, Indiana, USA.
authors.forename: Emma
authors.initials: E
authors.lastname: Tillman
authors.affiliation: 1 Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee, USA.
authors.forename: Eunice Y
authors.initials: EY
authors.lastname: Huang
mesh_terms: D013505:Digestive System Surgical Procedures; D004750:Enteral Nutrition; D020345:Enterocolitis, Necrotizing; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D008895:Milk, Human; D010288:Parenteral Nutrition
keywords: enteral nutrition; feeding guideline; gastroschisis; intestinal atresia; intestinal surgery; intestinal volvulus; necrotizing enterocolitis; newborn infant; nutritional support; parenteral nutrition; practice guideline