Nutrition for Neonates Undergoing Surgery for CHD — Pre-op Enteral Feeding Readiness Assessment — Clinical Pathway: Inpatient

Nutrition for Neonates with Congenital Heart Disease Clinical Pathway — CICU

Pre-op Enteral Feeding Readiness Assessment

Initiate within 24 Hours of Admission

Studies have shown that early enteral nutrition decreases infection rates, length of stay, duration of mechanical ventilation, and improves wound healing, gut health, and immune support. Early enteral nutrition also provides an opportunity for the neonate to have positive early experiences with oral feeding.

The expectation is that most neonates will orally feed and self-regulate their volumes prior to surgery. For those who cannot orally feed, it is still beneficial to provide trophic enteral feeds. However, there is not enough evidence to support advancing beyond trophic tube feeds preoperatively without infant self-regulation.

Pre-op Enteral Feeding Readiness Assessment

Pathway Arm Patient Assessment
Initiate Oral Feeds Patients must be demonstrating oral feeding readiness based on these guidelines:
  • Patient on ≤ 2 L NC
  • Resp Rate < 70 breaths per minute
  • Demonstrating feeding cues:
    • Awake/alert
    • Rooting
    • Sucking on pacifier
    • Hands to mouth
Patient must also demonstrate the following:
  • Adequate cardiac output
  • Hemodynamics stable, weaning inotropic support
  • Stable rhythm or stable arrhythmia
  • No clinical seizure activity (> 12hrs)
  • No signs/symptoms of NEC or gut ischemia
Initiate Trophic Feeds Intubated or unable to orally feed, based on oral feeding readiness guidelines above, and demonstrates:
  • Adequate cardiac output
  • Hemodynamics stable, weaning inotropic support
  • Stable rhythm or stable arrhythmia
  • No clinical seizure activity (> 12hrs)
  • No signs/symptoms of NEC or gut ischemia
Parenteral Nutrition ONLY (NPO) Intubated or unable to orally feed, based on oral feeding readiness guidelines above, and demonstrates:
  • Low cardiac output
  • Hemodynamics stable but requiring inotropic support
  • Unstable arrhythmia
  • Clinical seizure activity
  • Concern for NEC
  • Intestinal obstruction
  • Escalating respiratory support or impending respiratory failure requiring intubation