748

Abstract

Introduction: Growth failure after pediatric cardiac surgery has been well documented. Despite evidence that enteral feeding reduces morbidity in critically ill patients, delivery of enteral nutrition (EN) is often inadequate. The purpose of this study was to determine whether implementation of a feeding protocol could improve EN delivery in infants following cardiac surgery. Methods: A feeding protocol for infants (0-6 months) following cardiac surgery was developed based on available evidence and multidisciplinary expertise. This protocol was implemented in a single-center, prospective case series and compared with historical controls in a pediatric cardiovascular ICU in a tertiary care children's hospital. The impact of this protocol was evaluated prospectively in infants following cardiac surgery. Results: Thirty one consecutive patients were evaluated, 15 historical controls and 16 patients receiving EN per protocol. Mean STAT scores, cardiopulmonary bypass times and lactate levels were comparable in each group (3 vs 3, p=0.948; 145.5 min vs 137.9 min, p=0.758; 2.5 vs 2.4 mg/dL, p=0.9463). Mean time to initiation of EN was improved in protocol patients and in subgroup evaluation of single ventricle patients (53 vs 25 hrs, p=0.02 and 72.5 vs 12 hrs, p=0.04). Proportion of patients reaching goal EN calories by 10 days post-op was also higher in protocol group (83% vs 47%, p=0.049). 0/4 patients with an open sternum received EN in historical group, compared to 2/3 in protocol group. Based on protocol, patients are eligible for EN if dopamine ≤5 mcg/kg/min, epinephrine ≤0.04 mcg/kg/min and lactate <4 mg/dL. 0 /10 patients on such vasopressors received EN in historical group, compared to 4/8 in protocol group. Evaluation of vasopressor requirements in historical patients revealed that 9 of 10 patients were eligible to receive EN within 24 hours post-op. No episodes of NEC or aspiration pneumonia were documented in either group. Conclusions: Development and use of an evidence-based feeding protocol improved time to initiation of EN and achievement of goal calories. Use of such a protocol is a safe and effective means of initiating and advancing enteral nutrition in infants undergoing cardiac surgery.