Reducing variation in feeding newborns with congenital heart disease

Objective: Enteral feeding is associated with decreased infection rates, decreased mechanical ventilation, decreased hospital length of stay, and improved wound healing. Enteral feeding difficulties are common in congenital heart disease. Our objective was to develop experience-based newborn feeding guidelines for the initiation and advancement of enteral feeding in the cardiothoracic intensive care unit. Design: This is a retrospective analysis of a quality improvement project. Setting: This quality improvement project was performed in a cardiothoracic intensive care unit. Patients: Newborns admitted to the cardiothoracic intensive care unit for cardiac surgery from January 2011 to May 2015 were retrospectively reviewed. Intervention: Newborn feeding guidelines for the initiation and advancement of enteral feeding were implemented in January 2012. Outcome measures: Guideline compliance and clinical variables before and after guideline implementation were reviewed. Results: Compliance with the guidelines increased from 83% in 2012 to 100% in the first two quarters of 2015. Preguidelines (January 2011–December 2011): 45 newborns underwent cardiac surgery; 8 deaths prior to discharge; 1 patient discharged from NICU, therefore, N = 36. Postguidelines (January 2012–May 2015): 131 newborns with 12 deaths, 12 admitted from home, 8 in the NICU, 3 on the floor preop, and 3 back transferred, therefore, N = 93. No difference in feeding preop (post 75% vs pre 69%; P =.5) or full po feeds at discharge (post 78% vs pre 89%; P =.2). Mesenteric ischemia was not statistically different postguidelines (post 6% vs pre 14%; P =.14). Length of hospital stay decreased postguidelines (post 27 + 17 d vs pre 34 + 42 d; P <.001). Conclusions: Implementation of experience-based newborn feeding guidelines for initiation and advancement of enteral feeding in the cardiothoracic intensive care unit was successful in reducing practice variation supported by increasing guideline compliance. Percentage of patient's full oral feeding at discharge did not change. Length of hospital stay was reduced although cannot be fully attributed to feeding guideline implementation.