Revision of a Standardized Feeding Protocol for Infants with Single Ventricle Physiology
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Authors
Kiler, Taylor
Issue Date
2023-05-13
Volume
Issue
Type
Manuscript
Language
Keywords
Infant(s) , Necrotizing Enterocolitis , Single Ventricle , Univentricular , Feeding Protocol , HLHS , Feeding Intolerance
Alternative Title
Abstract
Purpose: The purpose of this quality improvement project is to revise an established feeding protocol with the most up-to-date, evidence-based guidelines, including the management of feeding intolerance for infants with single ventricle physiology to prevent the development of necrotizing enterocolitis.
Background and Significance: Infants with single ventricle physiology have lower gut perfusion and limited systemic oxygenated blood flow, which directly contributes to mesenteric hypoperfusion and increases the risk of NEC. Pediatric organizations endorse the implementation of feeding protocols for infants who have undergone stage I palliation, although, to date, there is a lack of standardized feeding protocols within the CICU, and current feeding protocols vary between cardiac centers.
Problem Statement: Due to the devastating effects of NEC, professional organizations have published guidelines and nutrition recommendations in the form of clinical pathways, but cardiac centers still lack standardized implementation of feeding protocols specifically aimed at NEC prevention and the management of feeding intolerance. There is a need for up-to-date, evidence-based feeding protocols that include feeding intolerance recommendations for infants with single ventricle physiology.
Methods: The current feeding algorithm was revised based on evidence collected through literature review and provider counsel. The current pathways were revised to exclude checking gastric residuals after bolus feeds and include patients with a birth weight equal to or less than 3kg as the highest risk. Participants included infants who have undergone stage I palliation within a CICU in a children’s hospital located in Missouri.
Results: A total of 19 patients qualified for the QI project with 14 patients in the pre intervention cohort and 5 patients in the post intervention cohort. An increase in algorithm initiation was demonstrated with 80% of the post intervention group compared to 64% in the pre intervention group. An increased in algorithm adherence was also demonstrated by the 80% of post intervention patients who had an abdominal girth ordered compared to the 14% in the pre intervention group. Of the patients who had abdominal girths ordered, 3 out of 4 patients had daily abdominal girths documented. During the study period only 1 patient experienced a bloody stool compared to 50% in the pre intervention cohort. The diagnosis of necrotizing enterocolitis (20%) was unchanged between the two cohorts. All the post intervention patients with a birthweight of less than 3kg were placed on the appropriate “red” high risk feeding algorithm.
Discussion/conclusion: Algorithm adherence increased from 64% in the preintervention group to 80% in the post intervention group. While necrotizing enterocolitis diagnosis was unchanged the occurrence of bloody stools were decreased. More research is needed to identify feeding algorithm factors to decreased incidence of bloody stools and necrotizing enterocolitis.
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Publisher
Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University