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Implementation of feeding guidelines in infants at risk of intestinal failure
D R Shores1, J E Bullard2, S W Aucott2
1Department of Pediatric Gastroenterology, Johns Hopkins Children's Center, Baltimore, MD, USA.
Insights
Implementing new feeding guidelines for surgical infants significantly reduced the time to achieve enteral nutrition (EN) goals. This approach also decreased the incidence of parenteral nutrition-associated liver disease (PNALD) and improved key indicators like peak direct bilirubin.
Area of Science:
- Pediatric Surgery
- Neonatology
- Gastroenterology
Background:
- Parenteral nutrition-associated liver disease (PNALD) is a significant complication in infants requiring long-term parenteral nutrition (PN).
- Optimizing enteral nutrition (EN) advancement is crucial for reducing PN exposure and associated morbidities in surgical neonates.
Purpose of the Study:
- To implement and evaluate novel feeding guidelines aimed at accelerating EN advancement.
- To reduce the incidence of PNALD in infants undergoing intestinal surgery who require PN.
Main Methods:
- A pre-post implementation study design was used.
- Feeding guidelines with increased initial EN volume (10 to 20 ml/kg/day) and specific advancement criteria were introduced for infants <6 months.
- Outcomes including time to reach 50% goal EN calories, PNALD incidence, and peak direct bilirubin were compared before and after implementation.
Main Results:
- The initial EN volume was successfully increased.
- Time to reach 50% of goal EN calories was significantly reduced by a median of 6 days.
- PNALD incidence decreased from 70% to 48% (P=0.046), and median peak direct bilirubin levels dropped from 5.6 to 2.3 mg/dL (P=0.011).
- No significant change in necrotizing enterocolitis incidence was observed after resuming feeding.
Conclusions:
- Implementation of feeding guidelines with higher initial EN volumes is safe and well-tolerated in surgical infants.
- These guidelines accelerate EN caloric achievement and significantly reduce PNALD incidence and direct bilirubin levels.
- This strategy offers a promising approach to mitigate PN-related complications in vulnerable infants.
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).
Study Design:
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).
Conclusion:
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.
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