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

Nutrition for Neonates with Congenital Heart Disease Clinical Pathway — CICU

Post-op Enteral Feeding Readiness Assessment

Follow the patient assessment table below to determine which arm of the pathway to use for the patient.

  • Non-bypass cases: Post-op Day 0, 6 hrs post-op
  • Bypass cases: Post-op Day 1, AM rounds

Normal infant growth is associated with improved operative and long-term outcomes. Growth failure is prevalent in patients with congenital heart disease and has been associated with neurodevelopmental delay. Many factors may contribute to growth failure, including inadequate caloric delivery during the postoperative recovery period through transition to home.

The goal of these postoperative feeding recommendations is to optimize caloric delivery, based on the patient’s hemodynamic and medical stability and feeding tolerance.

Pathway Arm Patient Assessment
Parenteral Nutrition ONLY (NPO)
  • Concern for NEC
  • Intestinal obstruction
  • Hemodynamic instability with escalating inotropic support
  • Escalating respiratory support or impending respiratory failure requiring intubation
Initiate Trophic Feeds
  • Low cardiac output
  • Hemodynamics stable but requiring inotropic support
  • Unstable arrhythmia
  • Clinical seizure activity
  • No signs/symptoms of NEC or gut ischemia
Initiate Enteral Feeds
  • Adequate cardiac output
  • Hemodynamics stable, weaning inotropic support
  • Stable rhythm or stable arrhythmia
  • No clinical seizure activity (> 12 hrs)
  • No signs/symptoms of NEC or gut ischemia