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Enteral feeding algorithm for infants with hypoplastic left heart syndrome poststage I palliation
Nancy J Braudis1, Martha A Q Curley, Karen Beaupre
1Department of Nursing, Cardiac Intensive Care Unit, Children's Hospital Boston, Boston, MA, USA. nancy.braudis@childrens.harvard.edu
Insights
An enteral feeding algorithm safely and effectively supports growth in infants with hypoplastic left heart syndrome (HLHS) post-surgery. This approach reduces parenteral nutrition dependence and time to full caloric intake without increasing necrotizing enterocolitis risk.
Area of Science:
- Pediatric Cardiology
- Neonatal Nutrition
- Surgical Outcomes
Background:
- Infants with hypoplastic left heart syndrome (HLHS) often experience growth failure after stage I palliation.
- Early enteral feeding is challenging due to necrotizing enterocolitis (NEC) risk.
- Limited guidelines exist for enteral feeding in this high-risk population.
Purpose of the Study:
- To evaluate the safety and efficacy of a novel enteral feeding algorithm.
- To assess the algorithm's impact on nutritional outcomes and NEC incidence in infants with HLHS.
Main Methods:
- Prospective case series with historical controls in a pediatric cardiovascular intensive care unit.
- Implementation of a standardized enteral feeding algorithm for initiation and advancement.
- Comparison of outcomes between patients who received the algorithm and a historical cohort.
Main Results:
- Significantly reduced duration of total parenteral nutrition (TPN) in the algorithm group (51 vs. 116 hours).
- Faster achievement of the recommended daily caloric intake (9 vs. 13 days).
- Zero incidence of NEC in the algorithm group compared to 11% in the control group.
Conclusions:
- The enteral feeding algorithm is safe and effective for nutritional support in infants with HLHS post-stage I palliation.
- Early and rapid advancement of enteral nutrition is feasible without compromising safety.
- Algorithm implementation improves nutritional outcomes and reduces TPN reliance.
Background:
Infants with hypoplastic left heart syndrome (HLHS) experience a high incidence of growth failure in the postoperative period following stage I palliation. Because of an increased risk of necrotizing enterocolitis in this population, clinicians may be reluctant to initiate early enteral feedings. Published guidelines for initiating and advancing enteral feedings in this population are limited.
Objective:
To test the safety and efficacy of an enteral feeding algorithm in infants with HLHS following stage I palliation.
Design:
Single-center, prospective case series with historical comparisons.
Setting:
Pediatric cardiovascular intensive care unit in tertiary care children's hospital.
Patients:
The study group consisted of consecutive patients > or =35 wks gestational age and weight > or =2 kg admitted to our cardiac intensive care unit over an 18-month period following stage I palliation of HLHS (n = 36). Excluded were nonsurvivors, patients supported on extracorporeal membrane oxygenation or those with a history of NEC or fetal intervention. These data were compared with a similar cohort of patients admitted to the cardiac intensive care unit over an 18-month period before the implementation of the feeding algorithm (n = 27).
Intervention:
A feeding algorithm was implemented in the study group in the postoperative period for initiation and advancement of enteral nutrition.
Measurements And Main Results:
The median duration of total parenteral nutrition was significantly higher in the control group (116 vs. 51 hrs; p = 0.03) compared with the study group. The median time to achieve recommended daily allowance of calories defined as 108 kcal/kg per day was significantly reduced in the study group (9 vs. 13 days; p = 0.01). Despite the rapid advancement of enteral feedings on the algorithm, there was no incidence of NEC in the study group compared with 11% in the control group.
Conclusion:
The use of an enteral feeding algorithm is a safe and effective means of initiating and advancing enteral nutrition in infants with HLHS following stage I palliation.
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