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Published on: April 17, 2020
Contemporary feeding practices in postoperative patients with Congenital Heart Disease
Ji-Yeon Kim1, Ajit Sarnaik1, Ahmad Farooqi2
1Division of Critical Care, Department of Pediatrics, Children's Hospital of Michigan/Central Michigan University, Detroit, MI, USA.
Insights
Nutritional practices for pediatric heart patients vary significantly, with few centers using gold-standard methods for calculating energy needs. Establishing feeding protocols improves early nutrition delivery and goal attainment post-surgery.
Area of Science:
- Pediatric Cardiology
- Nutritional Science
- Intensive Care Medicine
Background:
- Assessing current nutritional practices in postoperative patients with Congenital Heart Disease (CHD).
- Identifying variations in feeding strategies within pediatric cardiac intensive care units.
Purpose of the Study:
- To evaluate the current nutritional management of pediatric patients following cardiac surgery.
- To identify factors influencing feeding practices and adherence to guidelines.
Main Methods:
- A cross-sectional electronic survey was distributed to members of The Pediatric Cardiac Intensive Care Society.
- Data collected included respondent demographics, nutrition management roles, and feeding protocols.
Main Results:
- Most respondents (98%) would feed patients on inotropic/vasoactive support.
- Only 27% used indirect calorimetry for resting energy expenditure; academic hospitals were more likely to feed within 24 hours.
- Feeding protocols correlated with earlier feeding (within 24 hours) and achieving >50% goal intake by 48 hours.
Conclusions:
- Significant variability in feeding practices persists, despite 2017 guidelines.
- Institutional feeding protocols are associated with improved early feeding and goal intake.
- Underutilization of indirect calorimetry and knowledge gaps regarding caloric needs assessment were noted.
Background:
We aimed to assess the current nutritional practices in postoperative patients with Congenital Heart Disease.
Methods:
Cross-sectional electronic survey was sent to members of The Pediatric Cardiac Intensive Care Society.
Measurements And Main Results:
In Total, 52 members of the Pediatric Cardiac Intensive Care Society responded to the survey consisting of 14% paediatric intensivist, 53% paediatric cardiac intensivist, and 33% nurse/nurse practitioner with a median of 10 years of experience. There was an even distribution between intensivist (55%) and dietitian or nutritionist (45%) in nutrition management. Ninety-eight percent of respondents report that they would feed patients on inotropic or vasoactive support. Only 27% of respondents reported using indirect calorimetry in calculating resting energy expenditure which is the current gold standard. Academic hospitals compared to non-academic hospital were most likely to report feeding patients within 24 hours postoperative (p = 0.014). Having a feeding protocol was associated with feeding within 24 hours postoperative (p = 0.014) and associated with >50% goal intake by 48 hours postoperative (p = 0.025).
Conclusions:
Substantial variation in feeding practice still exists despite the American Society for Parenteral and Enteral Nutrition guidelines from 2017. Report of institutional established feeding protocol was associated with increased early feeding and reaching goal feeds by 48 hours postoperative. Very few centres reported use of indirect calorimetry in postoperative paediatric cardiac intensive care patients and many respondents lacked knowledge about applications in this population. Additional work to determine optimal feeding pathways and assessment of caloric needs in this population is needed.
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