Enteral feeding algorithm for infants with hypoplastic left heart syndrome poststage I palliation.

BACKGROUND: Infants with hypoplastic left heart syndrome (HLHS) experience a high incidence of growth failure in the postoperative period following stage I palliation. Because of an increased risk of necrotizing enterocolitis in this population, clinicians may be reluctant to initiate early enteral feedings. Published guidelines for initiating and advancing enteral feedings in this population are limited.

OBJECTIVE: To test the safety and efficacy of an enteral feeding algorithm in infants with HLHS following stage I palliation.

DESIGN: Single-center, prospective case series with historical comparisons.

SETTING: Pediatric cardiovascular intensive care unit in tertiary care children's hospital.

PATIENTS: The study group consisted of consecutive patients > or =35 wks gestational age and weight > or =2 kg admitted to our cardiac intensive care unit over an 18-month period following stage I palliation of HLHS (n = 36). Excluded were nonsurvivors, patients supported on extracorporeal membrane oxygenation or those with a history of NEC or fetal intervention. These data were compared with a similar cohort of patients admitted to the cardiac intensive care unit over an 18-month period before the implementation of the feeding algorithm (n = 27).

INTERVENTION: A feeding algorithm was implemented in the study group in the postoperative period for initiation and advancement of enteral nutrition.

MEASUREMENTS AND MAIN RESULTS: The median duration of total parenteral nutrition was significantly higher in the control group (116 vs. 51 hrs; p = 0.03) compared with the study group. The median time to achieve recommended daily allowance of calories defined as 108 kcal/kg per day was significantly reduced in the study group (9 vs. 13 days; p = 0.01). Despite the rapid advancement of enteral feedings on the algorithm, there was no incidence of NEC in the study group compared with 11% in the control group.

CONCLUSION: The use of an enteral feeding algorithm is a safe and effective means of initiating and advancing enteral nutrition in infants with HLHS following stage I palliation.