Nutrition for Neonates Undergoing Surgery for CHD — Prepare for Discharge — Clinical Pathway: Inpatient

Nutrition for Neonates with Congenital Heart Disease Clinical Pathway — CICU

Prepare for Discharge

As infants are being prepared for discharge, please consider the following:

  1. If an infant has any gastroenterology problems, recommend obtaining an outpatient follow-up appointment with Gastroenterology (GI/Nutrition) for long-term management.
  2. For non-interstage infants discharged home with a feeding tube, recommend infants obtain an outpatient nutrition follow-up appointment within 2-4 weeks of discharge. For those that do not live near Philadelphia, parents need to discuss with their PCP or local cardiologist to determine who will be primarily responsible for managing and advancing tube feeding regimen. It is important that infants on tube feeds have their feeding increased every 1-2 weeks to maintain adequate growth velocity.
  3. Consider follow-up with a speech therapist, as appropriate.

Prepare for Discharge

Discharge Criteria
  • Weight Gain: Aortopulmonary shunt-dependent infants require 20 grams/day weight gain averaged over 7 days before discharge.
  • All other infants may go home before this with close follow-up outpatient with PCP or Cardiologist.
Discharge Summary
  • In Discharge Summary, include:
    • Birth and discharge weights
    • Nutrition regimen for home, including caloric density, formula name, and mixing instructions
    • Advancement goals for enteral regimen
    • Outpatient nutrition appointment information (if appropriate)
After-visit Summary
  • FLOC to use .dischargenutrition in the after-visit summary for all infants on tube feeds. This includes information on enteral feeding regimen, mixing instructions, and advancement goals.
Discharge Teaching
  • Parents are required to receive education before discharge on special breast milk and/or formula mixing instructions, as well as for use of nasogastric tubes (when necessary).
Vitamin Supplementation
  • Rationale and instructions for prescribing:
    • The American Academy of Pediatrics (2008) recommends an additional 10 mcg (400 units) once daily of vitamin D for breastfed infants or infants receiving < 1000 mL/day of formula.
    • Order Tri-Vi-Sol 1 mL/day or cholecalciferol liquid suspension (Inpatient: 20 mcg (800 units) every other day, Outpatient: 10 mcg (400 units) once daily ).

Outpatient Nutrition Information

Schedule Outpatient Nutrition Follow-up Appointment within 2-4 weeks of Discharge
  • Interstage infants followed by ISVMP will automatically be followed by outpatient cardiac dietitian and NP, with monitoring of weekly weights and close monitoring and advancing of enteral feeding regimens.
  • For non-interstage infants discharged home with a feeding tube or need for close nutrition monitoring, recommend obtaining outpatient nutrition follow-up appointment within 2-4 weeks of discharge.
    • Exclusively breastfeeding infants and lactating mothers may consider follow-up in lactation clinic.
Cardiology Nutrition Clinic (Main Hospital)
  • Location: CHOP Buerger Center, 12th Floor Cardiology Clinic
  • Outpatient Cardiac Dietitian: Danielle Campbell
  • Appointment number: 215-590-4040
Satellite Nutrition Clinics
  • Other outpatient nutrition clinics are also offered on various days in several satellite locations; however, wait time for an appointment may be significantly longer. To make appointment at any satellite nutrition clinic, call 215-590-3630.
Glen Mills, PA King of Prussia, PA
Bucks County, PA Princeton, NJ
Exton, PA Voorhees, NJ
Lactation Clinic
  • Schedule: by appointment, flexible scheduling
  • Appointment number: 215-590-4442
Oral Feeding Therapy
  • For infants with ongoing oral feeding therapy needs, the speech therapist will assist caregivers in determining appropriate follow-up/discharge plans.

Instructions for WIC

Instructions for completing WIC Prescription for Special Formula
  • Formula/fortifier requested:
    • Formula name only (e.g., Similac Advance) — do not list caloric density here.
  • Special instructions for preparation and use:
    • List here any specific instructions related to caloric density or fortifying breast milk.
    • Example:
      • Patient has been instructed to mix Similac Advance powder to 24 cal/oz.
      • Patient has been instructed to fortify breast milk with Similac Advance powder to 24 cal/oz.
  • Amounts provided from WIC:
    • WIC will only provide max allotted cans regardless of caloric density (0-3 months = 9 cans/month, 4-6 months = 10 cans/month, > 6 months = 7 cans/month + food unless physician specifies restricted food and instructs WIC to give maximum allowed formula in lieu of baby food).
  • WIC contracted formulas:
    • PA WIC: Similac Advance/Similac Isomil. Non-standard formulas need a prescription.
    • NJ WIC: Enfamil Infant/Enfamil Prosobee. Non-standard formulas need a prescription.