Standardization of Feeding Advancement After Neonatal Gastrointestinal Surgery

Abstract

Utilization of a feeding guideline is safe and standardizes care within an institution, improving compliance to evidence-based practices and outcomes.

Use of a Gastroschisis Feeding Guideline to Improve Standardization of Care and Patient Outcomes at an Urban Children's Hospital

“…The percent of remaining small bowel for infants treated on the PIS protocol was determined by dividing the remaining small‐bowel length as measured by the operative surgeon by the expected average neonatal small‐bowel length based on gestational age as determined by a previous publication (19–27 weeks gestational age, 140 cm; 27–35 weeks, 220 cm; >35 weeks, 300 cm), and multiplying that factor by 100 …”

“…The percent of remaining small bowel for infants treated on the PIS protocol was determined by dividing the remaining small-bowel length as measured by the operative surgeon by the expected average neonatal small-bowel length based on gestational age as determined by a previous publication (19-27 weeks gestational age, 140 cm; 27-35 weeks, 220 cm; >35 weeks, 300 cm), and multiplying that factor by 100. [20][21][22] Length of stay was calculated as the number of days the infant spent in the hospital from their arrival date to discharge after gastroschisis repair. No infants included in the study were discharged before reaching full enteral feeds.…”

“…Feeding advancement was based on residual small‐bowel length after intestinal surgery and weight at initiation of feeds. We assessed the safety and efficacy of this guideline in a previous study, finding less severe cholestasis and increased breast milk use in the postimplementation group, and 67% adherence to the guideline . However, during this evaluation, we also noted that our simple gastroschisis patients were being categorized into >1 feeding advancement category (either 1‐day advancement or 3‐day advancement) by the clinicians using this protocol despite the fact that these patients did not have any bowel resected.…”

Evolution of Resting Energy Expenditure, Respiratory Quotient, and Adiposity in Infants Recovering from Corrective Surgery of Major Congenital Gastrointestinal Tract Anomalies: A Cohort Study

“…Nutritional management specifically for infants recovering from corrective surgery of major congenital anomalies is not well defined, and recommendations for energy and macronutrients intake are needed [ 18 , 19 , 20 ]. Surgical neonates may need extra energy supply to reduce fat oxidation and facilitate lipogenesis, considering that increased protein synthesis for tissues repair in postsurgical period is a high energy-requiring process [ 21 ].…”

Probiotic research in neonates with congenital gastrointestinal surgical conditions – Now is the time

“…The major congenital gastrointestinal surgical conditions (CGISC) include oesophageal atresia, gastroschisis, exomphalos, malrotation and volvulus, duodenal atresia, intestinal atresia, meconium ileus, hypoplastic colon, meconium peritonitis, intestinal stenosis, congenital short bowel syndrome, Hirschsprung disease (HD), anorectal malformations and others. In addition to surgical repair, strategies for managing such conditions include early commencement of enteral feeds, standardization of feeding advancement, strict hand hygiene and aseptic precautions for indwelling catheters (Graham, ; Lauriti et al ., ; Savoie et al ., ; Dama et al ., ). Despite such best practices and advances in surgical techniques, morbidities including feed intolerance, healthcare‐associated infections, cholestatic jaundice, growth failure and neurodevelopmental disabilities continue to impose significant health burden on this cohort (Willis et al ., ; Bishay et al ., ; Wang et al ., ; Dwyer et al ., ; Hong et al ., ).…”