Inpatient Pathway for the Evaluation/Treatment of Fetus or Newborn with Single Ventricle

Feeding Protocal for Newborn with Single Ventricle

Single Ventricle Patient
Duct-Dependent Blood Flow
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If no contraindications start
Parenteral Nutrition
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Central Access
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YES
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NO
Start DOL#1 with D10%, AA 2 g/kg, lipids 2 g/kg
Check TPN Panel, advance dextrose, AA, lipids
t/c PPN or lipids only if Stage 1 scheduled for ≥DOL#4
Limit to ≤D10%, AA 2 g/kg, lipids 2 g/kg, <1000 mOsm/L
Do not exceed 1 mEq/kg for CaGluc and/or NaPhos
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If no contraindications, start
trophic enteral feeds
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YES
Oral feeding appropriate?
NO
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1 mL/hr via NG (< 3 kg)
1-2 ml/hr via NG (> 3 kg)
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YES
5 mL Q 3hr (< 3 kg)
10 mL Q 3hr (> 3 kg)
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Monitor abd girth daily
Hemocult stool check
D0
D1
Nothing
Institute
Parenteral Feeds
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Early Extubation
(< D3)
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No
Stable?
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Yes
Institute Trophic NG Feeds and advance
Yes
Extubate
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Institute NG feeds if meets previous criteria, advance per protocol
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Evaluate for PO feeding
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Stridor
Present?
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Yes
ENT Evaluation
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Eval positive(paralyzed cord)
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Start PO Feeding
Speech
Evaluation
Pass
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No
Eval Negative
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Speech
Evaluation
Modified barium swallow for aspiration from above
Negative
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Pass
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Advance Feeding
per protocol
Cine swallow (Speech) for aspiration from above
Fail
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Assess po
intakes at 7-10
days
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> 10% of caloric
requirements
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Discharge on NG
+ PO
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Negative
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< 10% caloric
requirements
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G Tube evaluation
and Procedure
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Positive
Fail
Discharge with G
tube feeding
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Positive
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Preop
Operation