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Advancement of a standardised enteral feeding protocol in functional single ventricle patients following stage I palliation using cerebro-somatic near-infrared spectroscopy

Published online by Cambridge University Press:  24 August 2020

Tia T. Raymond Open the ORCID record for Tia T. Raymond [Opens in a new window] ,
Selena Valle ,
Janie Garza ,
Samrat Yeramaneni ,
Elena Wurtz ,
Brooke Sample ,
Nicole Kozak ,
William Stigall ,
Scott Gatlin  and
Grant Burton
Tia T. Raymond*
Affiliation:
Department of Pediatrics, Cardiac Intensive Care, Medical City Children’s Hospital, Dallas, TX, USA
Selena Valle
Affiliation:
HCA Research Institute at Medical City Children’s Hospital, Dallas, TX, USA
Janie Garza
Affiliation:
Children’s Health, Division of Cardiology, Dallas, TX, USA
Samrat Yeramaneni
Affiliation:
HCA Research Institute at Medical City Children’s Hospital, Dallas, TX, USA
Elena Wurtz
Affiliation:
Department of Pediatrics, Cardiac Intensive Care, Medical City Children’s Hospital, Dallas, TX, USA
Brooke Sample
Affiliation:
Department of Pediatrics, Cardiac Intensive Care, Medical City Children’s Hospital, Dallas, TX, USA
Nicole Kozak
Affiliation:
Department of Pediatrics, Cardiac Intensive Care, Medical City Children’s Hospital, Dallas, TX, USA
William Stigall
Affiliation:
Pediatric Critical Care, Cook Children’s Hospital, Fort Worth, TX, USA
Scott Gatlin
Affiliation:
Department of Pediatrics, Division of Cardiology, Arkansas Children’s Hospital, Little Rock, AR, USA
Grant Burton
Affiliation:
Department of Pediatrics, Cardiac Intensive Care, Medical City Children’s Hospital, Dallas, TX, USA
*
Author for correspondence: Tia T. Raymond., MD, FAAP, FAHA, Pediatric Cardiac Intensivists of North Texas, PLLC, Medical City Children’s Hospital, 7777 Forest Lane, Suite C-300J, Dallas, TX75230, USA. Tel: +1 972-566-2043/+1 972-533-7175; Fax: +1 866-665-5336. E-mail: tiaraymond@me.com
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Abstract

Introduction:

Infants with single ventricle following stage I palliation are at risk for poor nutrition and growth failure. We hypothesise a standardised enteral feeding protocol for these infants that will result in a more rapid attainment of nutritional goals without an increased incidence of gastrointestinal co-morbidities.

Materials and methods:

Single-centre cardiac ICU, prospective case series with historical comparisons. Feeding cohort consisted of consecutive patients with a single ventricle admitted to cardiac ICU over 18 months following stage I palliation (n = 33). Data were compared with a control cohort and admitted to the cardiac ICU over 18 months before feeding protocol implementation (n = 30). Feeding protocol patients were randomised: (1) protocol with cerebro-somatic near-infrared spectroscopy feeding advancement criteria (n = 17) or (2) protocol without cerebro-somatic near-infrared spectroscopy feeding advancement criteria (n = 16).

Results:

Median time to achieve goal enteral volume was significantly higher in the control compared to feeding cohort. There were no significant differences in enteral feeds being held for feeding intolerance or necrotising enterocolitis between cohorts. Feeding cohort had significant improvements in discharge nutritional status (weight, difference admit to discharge weight, weight-for-age z score, volume, and caloric enteral nutrition) and late mortality compared to the control cohort. No infants in the feeding group with cerebro-somatic near-infrared spectroscopy developed necrotising enterocolitis versus 4/16 (25%) in the feeding cohort without cerebro-somatic near-infrared spectroscopy (p = 0.04).

Conclusions:

A feeding protocol is a safe and effective means of initiating and advancing enteral nutrition in infants following stage I palliation and resulted in improved nutrition delivery, weight gain, and nourishment status at discharge without increased incidence of gastrointestinal co-morbidities.

Keywords

PaediatricsCHDnutritionpaediatric cardiac surgerynear-infrared spectroscopy
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 11 , November 2020 , pp. 1649 - 1658
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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