Objective: To evaluate how outcomes changed in newborns undergoing surgery for congenital heart disease (CHD) after implementation of a standardized pre- and post-operative nutrition program.
Study design: We performed a single-center cohort study of newborns who underwent cardiac surgery between September 2008 and July 2015. We evaluated growth and feeding outcomes in the 2 years of pre-program time (phase 0), in the 2 years after initiation of a post-operative feeding algorithm (phase 1), and in the 2 years following introduction of a pre-operative feeding program (phase 2) using traditional statistics and quality improvement methods.
Results: The study included 570 newborns with CHD. Weight-for-age z-score change from birth to hospital discharge significantly improved from phase 0 (-1.02 [IQR -1.45 to -0.63]) to phase 1(-0.83 [IQR -1.25 to -0.54]; p=0.006), with this improvement maintained in phase 2 (-0.89 [IQR -1.30 to -0.56]; P = .017 across phases). Gastrostomy (G)-tube utilization declined significantly (25% in phase 0 versus 12% and 14% in phases 1 and 2; p<0.001) and pre-operative enteral feeding increased significantly (47% and 46% in phases 0 and 1 versus 76% in phase 2; p<0.001) without increases in necrotizing enterocolitis (NEC), hospital stay, or mortality.
Conclusions: Introduction of a multi-interventional nutrition program was associated with improved weight gain, fewer gastrostomy-tubes at hospital discharge, and increased pre-operative enteral feeding without increases in NEC, hospital stay, or mortality.