title: Reducing variation in feeding newborns with congenital heart disease.
abstract: OBJECTIVE
  Enteral feeding is associated with decreased infection rates, decreased mechanical ventilation, decreased hospital length of stay, and improved wound healing. Enteral feeding difficulties are common in congenital heart disease. Our objective was to develop experience-based newborn feeding guidelines for the initiation and advancement of enteral feeding in the cardiothoracic intensive care unit.
  
  
  METHODS
  This is a retrospective analysis of a quality improvement project.
  
  
  METHODS
  This quality improvement project was performed in a cardiothoracic intensive care unit.
  
  
  METHODS
  Newborns admitted to the cardiothoracic intensive care unit for cardiac surgery from January 2011 to May 2015 were retrospectively reviewed.
  
  
  METHODS
  Newborn feeding guidelines for the initiation and advancement of enteral feeding were implemented in January 2012.
  
  
  METHODS
  Guideline compliance and clinical variables before and after guideline implementation were reviewed.
  
  
  RESULTS
  Compliance with the guidelines increased from 83% in 2012 to 100% in the first two quarters of 2015. Preguidelines (January 2011-December 2011): 45 newborns underwent cardiac surgery; 8 deaths prior to discharge; 1 patient discharged from NICU, therefore, N = 36. Postguidelines (January 2012-May 2015): 131 newborns with 12 deaths, 12 admitted from home, 8 in the NICU, 3 on the floor preop, and 3 back transferred, therefore, N = 93. No difference in feeding preop (post 75% vs pre 69%; P = .5) or full po feeds at discharge (post 78% vs pre 89%; P = .2). Mesenteric ischemia was not statistically different postguidelines (post 6% vs pre 14%; P = .14). Length of hospital stay decreased postguidelines (post 27 + 17 d vs pre 34 + 42 d; P < .001).
  
  
  CONCLUSIONS
  Implementation of experience-based newborn feeding guidelines for initiation and advancement of enteral feeding in the cardiothoracic intensive care unit was successful in reducing practice variation supported by increasing guideline compliance. Percentage of patient's full oral feeding at discharge did not change. Length of hospital stay was reduced although cannot be fully attributed to feeding guideline implementation.
authors.affiliation: The Heart Center at Nationwide Children's Hospital, Columbus, OH, 43205, USA.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Simsic
authors.affiliation: The Heart Center at Nationwide Children's Hospital, Columbus, OH, 43205, USA.
authors.forename: Kirby-Rose
authors.initials: KR
authors.lastname: Carpenito
authors.affiliation: The Heart Center at Nationwide Children's Hospital, Columbus, OH, 43205, USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Kirchner
authors.affiliation: The Heart Center at Nationwide Children's Hospital, Columbus, OH, 43205, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Peters
authors.affiliation: The Heart Center at Nationwide Children's Hospital, Columbus, OH, 43205, USA.
authors.forename: Holly
authors.initials: H
authors.lastname: Miller-Tate
authors.affiliation: The Heart Center at Nationwide Children's Hospital, Columbus, OH, 43205, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Joy
authors.affiliation: The Heart Center at Nationwide Children's Hospital, Columbus, OH, 43205, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Galantowicz
mesh_terms: D004750:Enteral Nutrition / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006330:Heart Defects, Congenital / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000592:standards*; D008297:Male; D058996:Quality Improvement; D012189:Retrospective Studies
keywords: cardiac surgery; congenital heart disease; feeding; intensive care unit; newborn; quality improvement