Nutrition for Neonates Undergoing Surgery for CHD — Ongoing Monitoring and Fortification Guidelines — Clinical Pathway: Inpatient

Nutrition for Neonates with Congenital Heart Disease Clinical Pathway — CICU

Ongoing Monitoring and Fortification Guidelines

Ongoing Monitoring

Daily
  • Weight
  • Actual calorie intake (review on rounds)
  • Goal calories ordered (review on rounds and compare with actual calorie intake)
Weekly
  • Head circumference
  • Length
NG Tube
  • Leave 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.
Poor Weight Gain
  • Consult RD prior to fortification
  • See fortification guidelines

Fortification Guidelines

Indications for Fortification
  • If infant is unable to reach the calorie goal due to volume restrictions.
  • If infant has lost more than 10% of birth weight by 14 days of life.
  • If infant cannot tolerate ≥ 160 mL/kg/day of breast milk.

Please Note:

  • Do not recommend fortification at less than 14 days of age unless recommended by RD.
  • Weigh the risk/benefit of fortifying before 14 days of age.
Instructions for Fortification
  • Consider hindmilk for fortification (discuss with lactation consultant).
  • Fortify to 22 kcal/oz after 24 hours of tolerating goal volume.
  • Advance to 24 kcal/oz, if needed, after 24 hours of tolerating 22 kcal/oz.
  • Do not increase to 27 kcal/oz unless discussed with RD.
  • Inpatient fortification: Fortification with formula liquid concentrate preferred for safety and sterility in formula room/Human Milk Management Center.
  • Use standard infant formula for fortification, unless otherwise indicated by RD.