Nutrition for Neonates Undergoing Surgery for CHD — Advance Enteral — Clinical Pathway: Inpatient

Nutrition for Neonates with Congenital Heart Disease Clinical Pathway — CICU

Advance Enteral

Follow the steps below to advance to goal volume first, then goal calories:

Enteral Feed Advance Table to Reach Goal Volume

  Continuous (NG/ND) Bolus (PO/NG) Goal/Volume*
Normal Advance
  • • Patients ≥ 3 days of age
  • < 3 kg
    • Initiate at 1 mL/hr
    • Advance by 1 mL/hr q 6 hr to goal*
  • ≥ 3 kg
    • Initiate at 2 mL/hr
    • Advance by 2 mL/hr q 6 hr to goal*
  • Initiate at 15 mL q 3 hr
  • Advance by 5 mL q 6 hr to goal
  • Please add in the diet order comments the dot phrase .cardiacpoadlib1
  • Advance to goal of
    150 mL/kg/day
Slow Advance
  • • < 37 weeks gestation
  • • Patients < 3 days of age
  • • Ready to advance from
      NPO or trophic feeds
  • < 3 kg
    • Initiate at 1 mL/hr
    • Advance by 1 mL/hr q 12 hr to goal*
  • ≥ 3 kg
    • Initiate at 1 mL/hr
    • Advance by 1 mL/hr q 6 hr to goal*
  • Initiate at 5 mL q 3 hr
  • Advance by 5 mL q 6 hr to goal
  • Please add in the diet order comments the dot phrase .cardiacpoadlib1
  1. .cardiacpoadlib: Minimum feed volume is *** mL every 3 hrs. Infant may take more than minimum volume. Feeding frequency based on infant's cues. Do not go longer than 3 hours without offering a feed. Notify ordering provider if not taking minimum feed volume.

Advancing (or Titrating) PN While Advancing Enteral Nutrition

When enteral feeds are initiated, any enteral volume administered may exceed the intravenous TFL of 100 ml/kg/day up to 130 ml/kg/day prior to weaning PN.

  • Continue intravenous lipids until enteral caloric intake ≥ 100 kcal/kg/day.
  • Once goal enteral nutrition achieved, discontinue TFL order.
  • Discuss/evaluate TFL order daily.

Advance to Goal Calories

Goal volume of 150 mL/kg/day will provide minimum requirement of 100 kcal/kg/day. Once goal volume is reached, assess growth and determine further caloric goals with dietitian. Infants may require a further increase in volume, hindmilk and/or fortification (See Fortification Guidelines).

**Leave NG Tube in place until neonate meets goal calories by mouth for 2 consecutive days.**

If exclusively breastfeeding, may remove NG tube if the mother’s milk supply is established per lactation consultant and the infant is breastfeeding a minimum of 8 times per day for 2 consecutive days.

Nursing Documentation of Enteral Calories (kcal/kg/day):

  • In EPIC Intake Flowsheet, choose “add rows” and search “kcal.” Then choose “Caloric intake past 24 hours.”
  • For every feed amount that is documented in EPIC, also document the calorie per ounce so that EPIC can accurately calculate the enteral intake (kcal/kg) received.
  • The total enteral kcal/kg/day will automatically appear in the CICU and CCU rounding tools. Please read the 6 a.m. value when presenting daily intake on rounds.

See EPIC Documentation of Enteral Calories