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Implementation of feeding guidelines in infants at risk of intestinal failure

Journal of Perinatology volume 35, pages 941–948 (2015)Cite this article

Subjects

Abstract

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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Acknowledgements

We thank Jennifer Shepard who assisted with data collection, and other team members who assisted in implementation: Howard Pryor, MD, Daniel Rhee, MD, Karen Frank, DNP, Beth Diehl-Svrjcek, NP, and Lynn Morooney, NP. This publication was made possible by the Johns Hopkins Institute for Clinical and Translational Research (ICTR), which is funded in part by Grant Number 1KL2TR001077-01 from the National Center of Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins ICTAR, NCATS or NIH. This project was also partially funded by The Thomas Wilson Sanitarium for the Children of Baltimore City.

Author information

Authors and Affiliations

  1. Department of Pediatric Gastroenterology, Johns Hopkins Children’s Center, Baltimore, MD, USA

    D R Shores & K B Schwarz

  2. Department of Pediatric Neonatology, Johns Hopkins Children’s Center, Baltimore, MD, USA

    J E Bullard & S W Aucott

  3. Department of General Pediatric Surgery, Johns Hopkins Children’s Center, Baltimore, MD, USA

    F D Stewart

  4. Department of Pediatric Nutrition, Johns Hopkins Children’s Center, Baltimore, MD, USA

    C Haney & H Tymann

  5. Department of Pediatrics, Johns Hopkins Children’s Center, Baltimore, MD, USA

    M R Miller

  6. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    B A S Nonyane

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  1. D R Shores
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  2. J E Bullard
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  4. F D Stewart
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Correspondence to D R Shores.

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Shores, D., Bullard, J., Aucott, S. et al. Implementation of feeding guidelines in infants at risk of intestinal failure. J Perinatol 35, 941–948 (2015). https://doi.org/10.1038/jp.2015.105

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