Postoperative Feeding Guidelines Improve Outcomes in Surgical Infants

Background Early introduction of enteral nutrition (EN) in postoperative infants improves intestinal adaptation, reducing the risk of intestinal failure–associated liver disease (IFALD). Our objective was to determine whether guideline use reduces feeding variability and improves outcomes in the neo...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:JPEN. Journal of parenteral and enteral nutrition 2020-08, Vol.44 (6), p.1047-1056
Hauptverfasser: Shakeel, Fauzia, Newkirk, Melanie, Sellers, Austin, Shores, Darla R.
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 1056
container_issue 6
container_start_page 1047
container_title JPEN. Journal of parenteral and enteral nutrition
container_volume 44
creator Shakeel, Fauzia
Newkirk, Melanie
Sellers, Austin
Shores, Darla R.
description Background Early introduction of enteral nutrition (EN) in postoperative infants improves intestinal adaptation, reducing the risk of intestinal failure–associated liver disease (IFALD). Our objective was to determine whether guideline use reduces feeding variability and improves outcomes in the neonatal intensive care unit (NICU). Methods In a cohort study, surgical infants at risk for IFALD were evaluated pre and post implementation of feeding guidelines at 2 NICUs. A total of 167 guideline infants (2013–2018) were compared with 242 historical controls (2007–2013). Adherence was measured with timing and volume of initial postoperative feed. Primary outcomes were IFALD incidence and time to reach 50% and 100% of energy from EN. Secondary outcomes were parenteral nutrition (PN) days, postoperative necrotizing enterocolitis (NEC), central line–associated bloodstream infection (CLABSI), and length of stay (LOS). Results Moderate IFALD decreased from 32% to 20% (P = .005) in the guideline group. Time to achieve 50% and 100% energy from EN was decreased from medians of 8 to 5 and 28 to 21 days, respectively (P < .001). There was an overall decrease in PN use from 41 to 29 days (P = .002), CLABSI incidence from 25% to 5% (P < .001), and LOS from 70 to 53 days (P = .030). Once stratified by diagnosis, infants with NEC showed greatest improvement and reduction in IFALD from 67% to 42% (P = .045). With no difference in postoperative NEC (P = .464). Conclusion Early standardized postoperative EN guidelines in intestinal‐surgery infants was associated with improved outcomes, including faster achievement of feeding goals and reduced IFALD severity, especially in infants with NEC.
doi_str_mv 10.1002/jpen.1726
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2313360612</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2313360612</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3256-d053c01694a329e951fea8feb2759c5a36175c5ead08c7be05e4c7a20e42e6ef3</originalsourceid><addsrcrecordid>eNp1kE1PwkAQQDdGI4ge_AOmRz0UZr_p0RBADBES9dws2ylZ0i-7rYZ_bxH05mmT2ZeXmUfILYUhBWCjXYXFkGqmzkifRoKGTAhxTvpAxThUoGmPXHm_AwCuAC5Jj1MNUmrRJ9N16Zuywto07hODGWLiim0wb12CmSvQB4u8qsvua9U2tsy7gSuC17beOmuyYFGkpmj8NblITebx5vQOyPts-jZ5Cper-WLyuAwtZ1KFCUhugapIGM4ijCRN0YxT3DAtIysNV1RLK9EkMLZ6gyBRWG0YoGCoMOUDcn_0dit9tOibOHfeYpaZAsvWx4xT3p2oKOvQhyNq69L7GtO4ql1u6n1MIT5Uiw_V4kO1jr07adtNjskf-ZupA0ZH4MtluP_fFD-vpy8_ym8TAncC</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2313360612</pqid></control><display><type>article</type><title>Postoperative Feeding Guidelines Improve Outcomes in Surgical Infants</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Shakeel, Fauzia ; Newkirk, Melanie ; Sellers, Austin ; Shores, Darla R.</creator><creatorcontrib>Shakeel, Fauzia ; Newkirk, Melanie ; Sellers, Austin ; Shores, Darla R.</creatorcontrib><description>Background Early introduction of enteral nutrition (EN) in postoperative infants improves intestinal adaptation, reducing the risk of intestinal failure–associated liver disease (IFALD). Our objective was to determine whether guideline use reduces feeding variability and improves outcomes in the neonatal intensive care unit (NICU). Methods In a cohort study, surgical infants at risk for IFALD were evaluated pre and post implementation of feeding guidelines at 2 NICUs. A total of 167 guideline infants (2013–2018) were compared with 242 historical controls (2007–2013). Adherence was measured with timing and volume of initial postoperative feed. Primary outcomes were IFALD incidence and time to reach 50% and 100% of energy from EN. Secondary outcomes were parenteral nutrition (PN) days, postoperative necrotizing enterocolitis (NEC), central line–associated bloodstream infection (CLABSI), and length of stay (LOS). Results Moderate IFALD decreased from 32% to 20% (P = .005) in the guideline group. Time to achieve 50% and 100% energy from EN was decreased from medians of 8 to 5 and 28 to 21 days, respectively (P &lt; .001). There was an overall decrease in PN use from 41 to 29 days (P = .002), CLABSI incidence from 25% to 5% (P &lt; .001), and LOS from 70 to 53 days (P = .030). Once stratified by diagnosis, infants with NEC showed greatest improvement and reduction in IFALD from 67% to 42% (P = .045). With no difference in postoperative NEC (P = .464). Conclusion Early standardized postoperative EN guidelines in intestinal‐surgery infants was associated with improved outcomes, including faster achievement of feeding goals and reduced IFALD severity, especially in infants with NEC.</description><identifier>ISSN: 0148-6071</identifier><identifier>EISSN: 1941-2444</identifier><identifier>DOI: 10.1002/jpen.1726</identifier><identifier>PMID: 31705574</identifier><language>eng</language><publisher>United States</publisher><subject>Cohort Studies ; Enteral Nutrition ; Enterocolitis, Necrotizing - prevention &amp; control ; Humans ; Infant ; Infant, Newborn ; Infant, Very Low Birth Weight ; Intestinal Diseases ; neonates ; Parenteral Nutrition ; surgery</subject><ispartof>JPEN. Journal of parenteral and enteral nutrition, 2020-08, Vol.44 (6), p.1047-1056</ispartof><rights>2019 American Society for Parenteral and Enteral Nutrition</rights><rights>2019 American Society for Parenteral and Enteral Nutrition.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3256-d053c01694a329e951fea8feb2759c5a36175c5ead08c7be05e4c7a20e42e6ef3</citedby><cites>FETCH-LOGICAL-c3256-d053c01694a329e951fea8feb2759c5a36175c5ead08c7be05e4c7a20e42e6ef3</cites><orcidid>0000-0001-5981-7005</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjpen.1726$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjpen.1726$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31705574$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shakeel, Fauzia</creatorcontrib><creatorcontrib>Newkirk, Melanie</creatorcontrib><creatorcontrib>Sellers, Austin</creatorcontrib><creatorcontrib>Shores, Darla R.</creatorcontrib><title>Postoperative Feeding Guidelines Improve Outcomes in Surgical Infants</title><title>JPEN. Journal of parenteral and enteral nutrition</title><addtitle>JPEN J Parenter Enteral Nutr</addtitle><description>Background Early introduction of enteral nutrition (EN) in postoperative infants improves intestinal adaptation, reducing the risk of intestinal failure–associated liver disease (IFALD). Our objective was to determine whether guideline use reduces feeding variability and improves outcomes in the neonatal intensive care unit (NICU). Methods In a cohort study, surgical infants at risk for IFALD were evaluated pre and post implementation of feeding guidelines at 2 NICUs. A total of 167 guideline infants (2013–2018) were compared with 242 historical controls (2007–2013). Adherence was measured with timing and volume of initial postoperative feed. Primary outcomes were IFALD incidence and time to reach 50% and 100% of energy from EN. Secondary outcomes were parenteral nutrition (PN) days, postoperative necrotizing enterocolitis (NEC), central line–associated bloodstream infection (CLABSI), and length of stay (LOS). Results Moderate IFALD decreased from 32% to 20% (P = .005) in the guideline group. Time to achieve 50% and 100% energy from EN was decreased from medians of 8 to 5 and 28 to 21 days, respectively (P &lt; .001). There was an overall decrease in PN use from 41 to 29 days (P = .002), CLABSI incidence from 25% to 5% (P &lt; .001), and LOS from 70 to 53 days (P = .030). Once stratified by diagnosis, infants with NEC showed greatest improvement and reduction in IFALD from 67% to 42% (P = .045). With no difference in postoperative NEC (P = .464). Conclusion Early standardized postoperative EN guidelines in intestinal‐surgery infants was associated with improved outcomes, including faster achievement of feeding goals and reduced IFALD severity, especially in infants with NEC.</description><subject>Cohort Studies</subject><subject>Enteral Nutrition</subject><subject>Enterocolitis, Necrotizing - prevention &amp; control</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infant, Very Low Birth Weight</subject><subject>Intestinal Diseases</subject><subject>neonates</subject><subject>Parenteral Nutrition</subject><subject>surgery</subject><issn>0148-6071</issn><issn>1941-2444</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE1PwkAQQDdGI4ge_AOmRz0UZr_p0RBADBES9dws2ylZ0i-7rYZ_bxH05mmT2ZeXmUfILYUhBWCjXYXFkGqmzkifRoKGTAhxTvpAxThUoGmPXHm_AwCuAC5Jj1MNUmrRJ9N16Zuywto07hODGWLiim0wb12CmSvQB4u8qsvua9U2tsy7gSuC17beOmuyYFGkpmj8NblITebx5vQOyPts-jZ5Cper-WLyuAwtZ1KFCUhugapIGM4ijCRN0YxT3DAtIysNV1RLK9EkMLZ6gyBRWG0YoGCoMOUDcn_0dit9tOibOHfeYpaZAsvWx4xT3p2oKOvQhyNq69L7GtO4ql1u6n1MIT5Uiw_V4kO1jr07adtNjskf-ZupA0ZH4MtluP_fFD-vpy8_ym8TAncC</recordid><startdate>202008</startdate><enddate>202008</enddate><creator>Shakeel, Fauzia</creator><creator>Newkirk, Melanie</creator><creator>Sellers, Austin</creator><creator>Shores, Darla R.</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5981-7005</orcidid></search><sort><creationdate>202008</creationdate><title>Postoperative Feeding Guidelines Improve Outcomes in Surgical Infants</title><author>Shakeel, Fauzia ; Newkirk, Melanie ; Sellers, Austin ; Shores, Darla R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3256-d053c01694a329e951fea8feb2759c5a36175c5ead08c7be05e4c7a20e42e6ef3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Cohort Studies</topic><topic>Enteral Nutrition</topic><topic>Enterocolitis, Necrotizing - prevention &amp; control</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Infant, Very Low Birth Weight</topic><topic>Intestinal Diseases</topic><topic>neonates</topic><topic>Parenteral Nutrition</topic><topic>surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shakeel, Fauzia</creatorcontrib><creatorcontrib>Newkirk, Melanie</creatorcontrib><creatorcontrib>Sellers, Austin</creatorcontrib><creatorcontrib>Shores, Darla R.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>JPEN. Journal of parenteral and enteral nutrition</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shakeel, Fauzia</au><au>Newkirk, Melanie</au><au>Sellers, Austin</au><au>Shores, Darla R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Postoperative Feeding Guidelines Improve Outcomes in Surgical Infants</atitle><jtitle>JPEN. Journal of parenteral and enteral nutrition</jtitle><addtitle>JPEN J Parenter Enteral Nutr</addtitle><date>2020-08</date><risdate>2020</risdate><volume>44</volume><issue>6</issue><spage>1047</spage><epage>1056</epage><pages>1047-1056</pages><issn>0148-6071</issn><eissn>1941-2444</eissn><abstract>Background Early introduction of enteral nutrition (EN) in postoperative infants improves intestinal adaptation, reducing the risk of intestinal failure–associated liver disease (IFALD). Our objective was to determine whether guideline use reduces feeding variability and improves outcomes in the neonatal intensive care unit (NICU). Methods In a cohort study, surgical infants at risk for IFALD were evaluated pre and post implementation of feeding guidelines at 2 NICUs. A total of 167 guideline infants (2013–2018) were compared with 242 historical controls (2007–2013). Adherence was measured with timing and volume of initial postoperative feed. Primary outcomes were IFALD incidence and time to reach 50% and 100% of energy from EN. Secondary outcomes were parenteral nutrition (PN) days, postoperative necrotizing enterocolitis (NEC), central line–associated bloodstream infection (CLABSI), and length of stay (LOS). Results Moderate IFALD decreased from 32% to 20% (P = .005) in the guideline group. Time to achieve 50% and 100% energy from EN was decreased from medians of 8 to 5 and 28 to 21 days, respectively (P &lt; .001). There was an overall decrease in PN use from 41 to 29 days (P = .002), CLABSI incidence from 25% to 5% (P &lt; .001), and LOS from 70 to 53 days (P = .030). Once stratified by diagnosis, infants with NEC showed greatest improvement and reduction in IFALD from 67% to 42% (P = .045). With no difference in postoperative NEC (P = .464). Conclusion Early standardized postoperative EN guidelines in intestinal‐surgery infants was associated with improved outcomes, including faster achievement of feeding goals and reduced IFALD severity, especially in infants with NEC.</abstract><cop>United States</cop><pmid>31705574</pmid><doi>10.1002/jpen.1726</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-5981-7005</orcidid></addata></record>
fulltext fulltext
identifier ISSN: 0148-6071
ispartof JPEN. Journal of parenteral and enteral nutrition, 2020-08, Vol.44 (6), p.1047-1056
issn 0148-6071
1941-2444
language eng
recordid cdi_proquest_miscellaneous_2313360612
source MEDLINE; Access via Wiley Online Library
subjects Cohort Studies
Enteral Nutrition
Enterocolitis, Necrotizing - prevention & control
Humans
Infant
Infant, Newborn
Infant, Very Low Birth Weight
Intestinal Diseases
neonates
Parenteral Nutrition
surgery
title Postoperative Feeding Guidelines Improve Outcomes in Surgical Infants
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T21%3A39%3A10IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Postoperative%20Feeding%20Guidelines%20Improve%20Outcomes%20in%20Surgical%20Infants&rft.jtitle=JPEN.%20Journal%20of%20parenteral%20and%20enteral%20nutrition&rft.au=Shakeel,%20Fauzia&rft.date=2020-08&rft.volume=44&rft.issue=6&rft.spage=1047&rft.epage=1056&rft.pages=1047-1056&rft.issn=0148-6071&rft.eissn=1941-2444&rft_id=info:doi/10.1002/jpen.1726&rft_dat=%3Cproquest_cross%3E2313360612%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2313360612&rft_id=info:pmid/31705574&rfr_iscdi=true