Hostname: page-component-848d4c4894-4hhp2 Total loading time: 0 Render date: 2024-06-02T04:46:48.341Z Has data issue: false hasContentIssue false
  • English
  • Français

Contemporary feeding practices in postoperative patients with Congenital Heart Disease

Part of: Metabolic

Published online by Cambridge University Press:  15 March 2022

Ji-Yeon Kim Open the ORCID record for Ji-Yeon Kim [Opens in a new window] ,
Ajit Sarnaik ,
Ahmad Farooqi  and
Katherine Cashen
Ji-Yeon Kim*
Affiliation:
Division of Critical Care, Department of Pediatrics, Children’s Hospital of Michigan/Central Michigan University, Detroit, MI, USA
Ajit Sarnaik
Affiliation:
Division of Critical Care, Department of Pediatrics, Children’s Hospital of Michigan/Central Michigan University, Detroit, MI, USA
Ahmad Farooqi
Affiliation:
Children Research Institute, Central Michigan University, Detroit, MI, USA
Katherine Cashen
Affiliation:
Division of Critical Care, Department of Pediatrics, Duke University Hospital, Durham, NC, USA
*
Author for correspondence: J.-Y. Kim, MD, Division of Critical Care, Department of Pediatrics, Children’s Hospital of Michigan/Central Michigan University, 3901 Beaubien, Detroit, MI 48201, USA. Tel: 313-745-2495; Fax: 313-966-0105. E-mail: jkim@dmc.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

We aimed to assess the current nutritional practices in postoperative patients with Congenital Heart Disease.

Methods:

Cross-sectional electronic survey was sent to members of The Pediatric Cardiac Intensive Care Society.

Measurements and Main Results:

In Total, 52 members of the Pediatric Cardiac Intensive Care Society responded to the survey consisting of 14% paediatric intensivist, 53% paediatric cardiac intensivist, and 33% nurse/nurse practitioner with a median of 10 years of experience. There was an even distribution between intensivist (55%) and dietitian or nutritionist (45%) in nutrition management. Ninety-eight percent of respondents report that they would feed patients on inotropic or vasoactive support. Only 27% of respondents reported using indirect calorimetry in calculating resting energy expenditure which is the current gold standard. Academic hospitals compared to non-academic hospital were most likely to report feeding patients within 24 hours postoperative (p = 0.014). Having a feeding protocol was associated with feeding within 24 hours postoperative (p = 0.014) and associated with >50% goal intake by 48 hours postoperative (p = 0.025).

Conclusions:

Substantial variation in feeding practice still exists despite the American Society for Parenteral and Enteral Nutrition guidelines from 2017. Report of institutional established feeding protocol was associated with increased early feeding and reaching goal feeds by 48 hours postoperative. Very few centres reported use of indirect calorimetry in postoperative paediatric cardiac intensive care patients and many respondents lacked knowledge about applications in this population. Additional work to determine optimal feeding pathways and assessment of caloric needs in this population is needed.

Keywords

Paediatricenteral nutritionparental nutritionICUscongenital heartindirect calorimetry
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 12 , December 2022 , pp. 1938 - 1943
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Wong, JJM, Cheifetz, IM, Ong, C, Nakao, M, Lee, JH. Nutrition support for children undergoing congenital heart surgeries: a narrative review. World J Pediatr Congenit Heart Surg 2015; 6: 443–454.CrossRefGoogle ScholarPubMed
Floh, AA, Slicker, J, Schwartz, SM. Nutrition and mesenteric issues in pediatric cardiac critical care. Pediatr Crit Care Med 2016; 17: S243–S249.CrossRefGoogle ScholarPubMed
Mitting, R, Marino, L, Macrae, D, Shastri, N, Meyer, R, Pathan, N. Nutritional status and clinical outcome in postterm neonates undergoing surgery for congenital heart disease. Pediatr Crit Care Med 2015; 16: 448–452.CrossRefGoogle ScholarPubMed
Larsen, B, Goonewardene, L, Field, C, et al. Low energy intakes are associated with adverse outcomes in infants after open heart surgery. JPEN J Parenter Enteral Nutr 2013; 37: 254–260.CrossRefGoogle ScholarPubMed
Curzon, CL, Milford-Beland, S, Li, JS, et al. Cardiac surgery in infants with low birth weight is associated with increased mortality: analysis of the Society of Thoracic Surgeons Congenital Heart Database. J Thorac Cardiovasc Surg 2008; 135: 546–551.CrossRefGoogle Scholar
Briassoulis, G, Zavras, N, Hatzis, T. Malnutrition, nutritional indices, and early enteral feeding in critically ill children. Nutrition 2001; 17: 548–557.CrossRefGoogle ScholarPubMed
Pollack, MM, Ruttimann, UE, Wiley, JS. Nutritional depletions in critically ill children: associations with physiologic instability and increased quantity of care. JPEN J Parenter Enteral Nutr 1985; 9: 309–313.CrossRefGoogle ScholarPubMed
Mehta, NM, Bechard, LJ, Cahill, N, et al. Nutritional practices and their relationship to clinical outcomes in critically ill children—An international multicenter cohort study. Crit Care Med 2012; 40: 2204–2211.CrossRefGoogle ScholarPubMed
Hehir, DA, Easley, RB, Byrnes, J. Noncardiac challenges in the cardiac ICU: feeding, growth and gastrointestinal complications, anticoagulation, and analgesia. World J Pediatr Congenit Heart Surg 2016; 7: 199–209.CrossRefGoogle ScholarPubMed
Mehta, NM, Skillman, HE, Irving, SY, et al. Guidelines for the provision and assessment of nutrition support therapy in the pediatric critically ill patient: society of critical care medicine and American Society for parenteral and enteral nutrition. JPEN J Parenter Enteral Nutr 2017; 41: 706–742.CrossRefGoogle ScholarPubMed
Howley, LW, Kaufman, J, Wymore, E, et al. Enteral feeding in neonates with prostaglandin-dependent congenital cardiac disease: international survey on current trends and variations in practice. Cardiol Young 2012; 22: 121–127.CrossRefGoogle ScholarPubMed
Kerklaan, D, Fivez, T, Mehta, N, et al. Worldwide survey of nutritional practices in PICUs. Pediatr Crit Care Med 2015; 17: 10–18.CrossRefGoogle Scholar
Joffe, A, Anton, N, Lequier, L, et al. Nutritional support for critically ill children. Cochrane Database Syst Rev 2009; 2: CD005144.Google Scholar
Tume, LN, Balmaks, R, Cruz, E, et al. Enteral feeding practices in infants with congenital heart disease across European PICUs: A European Society of Pediatric and Neonatal Intensive Care Survey. Pediatr Crit Care Med 2018; 29: 137–144.CrossRefGoogle Scholar
Bechard, LJ, Duggan, C, Touger-Decker, R, et al. Nutritional status based on body mass index is associated with morbidity and mortality in mechanically ventilated critically ill children in the PICU. Crit Care Med 2016; 44: 1530–1537.CrossRefGoogle ScholarPubMed
de Souza Menezes, F, Leite, HP, Koch Nogueira, PC. Malnutrition as an independent predictor of clinical outcome in critically ill children. Nutrition 2012; 28: 267–270.CrossRefGoogle ScholarPubMed
Wong, JJ, Han, WM, Sultana, R, et al. Nutrition delivery affects outcomes in pediatric acute respiratory distress syndrome. JPEN J Parenter Enteral Nutr 2017; 41: 1007–1013.CrossRefGoogle ScholarPubMed
Meyer, R, Kulinskaya, E, Briassoulis, G, et al. The challenge of developing a new predictive formula to estimate energy requirements in ventilated critically ill children. Nutr Clin Pract 2012; 27: 669–676.CrossRefGoogle ScholarPubMed
Sy, J, Gourishankar, A, Gordon, WE, et al. Bicarbonate kinetics and predicted energy expenditure in critically ill children. Am J Clin Nutr 2008; 88: 340–347.CrossRefGoogle ScholarPubMed
Havalad, S, Quaid, MA, Sapiega, V. Energy expenditure in children with severe head injury: lack of agreement between measured and estimated energy expenditure. Nutr Clin Pract 2006; 21: 175–181.CrossRefGoogle ScholarPubMed
Hardy, CM, Dwyer, J, Snelling, LK, Dallal, GE, Adelson, JW. Pitfalls in predicting resting energy requirements in critically ill children: a comparison of predictive methods to indirect calorimetry. Nutr Clin Pract 2002; 17: 182–189.CrossRefGoogle ScholarPubMed
Newcombe, J, Fry-Bowers, E. A post-operative feeding protocol to improve outcomes for neonates with critical congenital heart disease. J Pediatr Nurs 2016; 35: 139–143.CrossRefGoogle Scholar
McElhinney, DB, Hedrick, HL, Bush, DM, et al. Necrotizing enterocolitis in neonates with congenital heart disease: risk factors and outcomes. Pediatrics 2000; 106: 1080–1087.CrossRefGoogle ScholarPubMed
Iannucci, GJ, Oster, ME, Mahle, WT. Necrotising enterocolitis in infants with congenital heart disease: the role of enteral feeds. Cardiol Young 2013; 23: 553–559.CrossRefGoogle ScholarPubMed
Ferguson, LP, Gandiya, T, Kaselas, C, Sheth, J, Hasan, A, Gabra, HOS. Gastrointestinal complications associated with the surgical treatment of heart disease in children. J Pediatr Surg 2017; 52: 414–419.CrossRefGoogle ScholarPubMed
Slicker, J, Hehir, DA, Horsley, M, et al. Nutrition algorithms for infants with hypoplastic left heart syndrome; birth through the first interstage period. Congenit Heart Dis 2013; 8: 89–102.CrossRefGoogle ScholarPubMed
Braudis, NJ, Curley, MA, Beaupre, K, et al. Enteral feeding algorithm for infants with hypoplastic left heart syndrome poststage I palliation. Pediatr Crit Care Med 2009; 10: 460–466.CrossRefGoogle ScholarPubMed
Panchal, AK, Manzi, J, Connolly, S, et al. Safety of enteral feedings in critically ill children receiving vasoactive agents. JPEN J Parenter Enteral Nutr 2016; 40: 236–241.CrossRefGoogle ScholarPubMed
Supplementary material: File

Kim et al. supplementary material

Kim et al. supplementary material

Download Kim et al. supplementary material(File)
File 26.7 KB