{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T19:21:25Z","timestamp":1790709685795,"version":"4.1.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2018,5,1]],"date-time":"2018-05-01T00:00:00Z","timestamp":1525132800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:sec><jats:title>Introduction:<\/jats:title><jats:p>Feeding difficulties and malnutrition are important challenges when caring for newborns with critical congenital heart disease (CCHD) without clear available guidelines for providers. This study describes the utilization of a feeding protocol with the focus on standardization, feeding modality, and total parenteral nutrition (TPN) utilization postoperatively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p>Patients included neonates with CCHD undergoing complex biventricular repair using cardiopulmonary bypass. Data were collected in 2013 preintervention and from 2015 to 2017 postintervention. The feeding protocol outlined guidelines for and postoperative use of TPN. Adverse outcomes data included rates of central line\u2013associated bloodstream infections, necrotizing enterocolitis, chylothorax, and vocal cord dysfunction. Balance outcomes measured were weight for age Z-score at discharge, number of abdominal radiographs obtained, readmission within 90 days, and central venous line utilization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>We included a total of 121 neonates: 49 in the preintervention group and 72 in the postintervention group. The protocol standardized feeding practices in CCHD neonates undergoing surgery with improved compliance from 70% early in the study period to 90% at the end of the study. Infants were fed enterally more preoperatively (86% versus 67%;<jats:italic toggle=\"yes\">P = 0<\/jats:italic>.023), reached a fluid goal sooner (63 hours versus 72 hours;<jats:italic toggle=\"yes\">P = 0<\/jats:italic>.035), and postoperative duration of TPN usage was significantly shorter in the postintervention period (48 hours versus 62 hours;<jats:italic toggle=\"yes\">P<\/jats:italic>= 0.041) with no increase in adverse outcome events or unintended consequences.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p>By implementing a feeding protocol, we reduced practice variation among providers, increased the number of patients fed enterally preoperatively and reduced postoperative use of TPN without increased complications.<\/jats:p><\/jats:sec>","DOI":"10.1097\/pq9.0000000000000080","type":"journal-article","created":{"date-parts":[[2019,6,11]],"date-time":"2019-06-11T20:48:49Z","timestamp":1560286129000},"page":"e080","source":"Crossref","is-referenced-by-count":30,"title":["Evaluating the Impact of a Feeding Protocol in Neonates before and after Biventricular Cardiac Surgery"],"prefix":"10.1097","volume":"3","author":[{"given":"Jamie","family":"Furlong-Dillard","sequence":"first","affiliation":[{"name":"Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaina","family":"Neary","sequence":"additional","affiliation":[{"name":"Primary Children\u2019s Hospital, Intermountain Healthcare, Salt Lake City, Utah."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Marietta","sequence":"additional","affiliation":[{"name":"Primary Children\u2019s Hospital, Intermountain Healthcare, Salt Lake City, Utah."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney","family":"Jones","sequence":"additional","affiliation":[{"name":"Primary Children\u2019s Hospital, Intermountain Healthcare, Salt Lake City, Utah."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Jeffers","sequence":"additional","affiliation":[{"name":"Primary Children\u2019s Hospital, Intermountain Healthcare, Salt Lake City, Utah."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey","family":"Gakenheimer","sequence":"additional","affiliation":[{"name":"Pediatrics Residency, Department of Pediatrics, University of Utah, Salt Lake City, Utah."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Puchalski","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Eckauser","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Delgado-Corcoran","sequence":"additional","affiliation":[{"name":"Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20230930","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1177\/0884533609332086","article-title":"Nutrition support after neonatal cardiac surgery.","volume":"24","author":"Owens","year":"2009","journal-title":"Nutr Clin Pract"},{"key":"R2-20230930","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.pedn.2016.12.010","article-title":"A post-operative feeding protocol to improve 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