Improving preoperative enteral feeding for newborns with congenital heart disease

Area of Science:

• Neonatal care
• Pediatric cardiology
• Quality improvement science

Background:

• Congenital heart disease (CHD) affects numerous newborns, often necessitating specialized care.
• Preoperative feeding is crucial for optimizing outcomes in neonates with CHD.
• Current feeding practices for these infants may be suboptimal, requiring targeted improvement.

Purpose of the Study:

• To enhance preoperative enteral feeding and breastfeeding rates in term neonates diagnosed with congenital heart disease (CHD).
• To implement and evaluate a standardized, evidence-based feeding protocol within a multidisciplinary setting.

Main Methods:

• A quality improvement project involving a multidisciplinary team to develop and implement a preoperative feeding protocol.
• Utilized data from the Pediatric Cardiac Critical Care Collaborative (PC4) and chart reviews for 121 neonates.
• Employed statistical process control charts to analyze data across pre-implementation, implementation, and sustainment phases.

Main Results:

• The rate of preoperative enteral feeding significantly increased from 72% to 93% post-implementation (p=0.026).
• Improvements were observed in secondary outcomes, including breastfeeding rates and time to first feed.
• No increase in the incidence of necrotizing enterocolitis was noted, indicating the protocol's safety.

Conclusions:

• A standardized, evidence-based feeding protocol, developed through interdisciplinary collaboration, effectively increased preoperative enteral feeding rates in neonates with CHD.
• The initiative demonstrated successful implementation and sustainment of improved feeding practices in a level IV intensive care nursery.
• This quality improvement project highlights the importance of structured protocols in managing complex pediatric conditions.