DOI QR코드

DOI QR Code

Development and Implementation of a Feeding Protocol for Infants in a Pediatric Cardiac Intensive Care Unit

소아심장외과 중환자실 장관영양 프로토콜 개발 및 효과평가

  • Uhm, Ju-Yeon (Graduate School, College of Nursing, Yonsei University) ;
  • Lee, Hyojin (Department of Nursing, Asan Medical Center)
  • 엄주연 (연세대학교 간호대학 대학원) ;
  • 이효진 (서울아산병원 간호부)
  • Received : 2016.08.26
  • Accepted : 2016.10.18
  • Published : 2016.10.31

Abstract

Purpose: It is crucial to provide adequate enteral nutrition for postoperative recovery, wound healing and normal growth in infants in pediatric cardiac ICUs. This study was done to develop a feeding protocol using the vaso-active inotropic (VAI) score and to evaluate the impact of nutritional outcomes following the new feeding protocol for infants who underwent cardiac surgery. Methods: This study consisted of three phases. First, a feeding protocol was developed based on a literature review. Second, ten experts rated the content validity. Third, a comparison study was conducted to evaluate the impact of the new feeding protocol. Data were analyzed using SPSS Version 20. Results: Twenty-nine infants were enrolled in the pre-protocol group, and 22 infants in the post-protocol group. Patients in the 2 groups were similar. Time to reach feeding goal was significantly decreased from 56.0 (27-210) hours to 28.5 (10-496) hours in the post-protocol group (Z=-4.22, p<.001). Level of enteral feeding knowledge among nurses increased significantly after implementation of the protocol. Conclusion: The feeding protocol using VAI score facilitates the achievement feeding goal to decrease feeding interruptions and help nurses in their practice. Larger studies are necessary to examine clinical outcomes following the implementation of this feeding protocol.

Keywords

References

  1. Anderson JB, Marino BS, Irving SY, Garcia-Espana JF, Ravishankar C, Stallings VA, et al. Poor post-operative growth in infants with two-ventricle physiology. Cardiology in the Young. 2011;21(4):421-429. http://dx.doi.org/10.1017/S1047951111000229
  2. Wang KS, Ford HR, Upperman JS. Metabolic response to stress in the neonate who has surgery. NeoReviews. 2006;7(8): 410-418. https://doi.org/10.1542/neo.7-8-e410
  3. Alpers DH. Enteral feeding and gut atrophy. Current Opinion in Clinical Nutrition and Metabolic Care. 2002;5(6):679-683. http://dx.doi.org/10.1097/01.mco.0000038812.16540.72
  4. Kogon BE, Ramaswamy V, Todd K, Plattner C, Kirshbom PM, Kanter KR, et al. Feeding difficulty in newborns following congenital heart surgery. Congenital Heart Disease. 2007;2(5):332-337. http://dx.doi.org/10.1111/j.1747-0803.2007.00121.x
  5. Varan B, Tokel K, Yilmaz G. Malnutrition and growth failure in cyanotic and acyanotic congenital heart disease with and without pulmonary hypertension. Archives of Disease in Childhood. 1999;81(1):49-52. https://doi.org/10.1136/adc.81.1.49
  6. Schwalbe-Terilli CR, Hartman DH, Nagle ML, Gallagher PR, Ittenbach RF, Burnham NB, et al. Enteral feeding and caloric intake in neonates after cardiac surgery. American Journal of Critical Care. 2009; 18(1):52-57. http://dx.doi.org/10.4037/ajcc2009405
  7. Meyer R, Harrison S, Sargent S, Ramnarayan P, Habibi P, Labadarios D. The impact of enteral feeding protocols on nutritional support in critically ill children. Journal of Human Nutrition and Dietetics. 2009;22(5): 428-436. http://dx.doi.org/10.1111/j.1365-277X.2009.00994.x
  8. Jeffries HE, Wells WJ, Starnes VA, Wetzel RC, Moromisato DY. Gastrointestinal morbidity after Norwood palliation for hypoplastic left heart syndrome. The Annals of Thoracic Surgery. 2006;81(3):982-987. http://dx.doi.org/10.1016/j.athoracsur.2005.09.001
  9. Kelleher DK, Laussen P, Teixeira-Pinto A, Duggan C. Growth and correlates of nutritional status among infants with hypoplastic left heart syndrome (HLHS) after stage 1 Norwood procedure. Nutrition. 2006;22(3):237-244. http://dx.doi.org/10.1016/j.nut.2005.06.008
  10. Woolsey CA, Coopersmith CM. Vasoactive drugs and the gut: Is there anything new? Current Opinion in Critical Care. 2006;12(2):155-159. http://dx.doi.org/10.1097/01.ccx.0000216584.72427.e4
  11. Mehta NM. Approach to enteral feeding in the PICU. Nutrition in Cl i n ical Pract ice. 2009;24(3):377-387. http://dx.doi. org/10.1177/0884533609335175
  12. Golbus JR, Wojcik BM, Charpie JR, Hirsch JC. Feeding complications in hypoplastic left heart syndrome after the Norwood procedure: A systematic review of the literature. Pediatric Cardiology. 2011;32(4): 539-552. http://dx.doi.org/10.1007/s00246-011-9907-x
  13. Bowman A, Greiner JE, Doerschug KC, Little SB, Bombei CL, Comried LM. Implementation of an evidence-based feeding protocol and aspiration risk reduction algorithm. Critical Care Nursing Quarterly. 2005;28(4):324-335. https://doi.org/10.1097/00002727-200510000-00004
  14. Reeves A, White H, Sosnowski K, Leveritt M, Desbrow B, Jones M. Multidisciplinary evaluation of a critical care enteral feeding algorithm. Nutrition and Dietetics. 2012;69(4):242-249. http://dx.doi.org/10.1111/ j.1747-0080.2012.01598.x
  15. Slicker J, Hehir DA, Horsley M, Monczka J, Stern KW, Roman B, et al. Nutrition Algorithms for Infants with Hypoplastic Left Heart Syndrome; Birth through the First Interstage Period. Congenital Heart Disease. 2013;8(2):89-102. http://dx.doi.org/10.1111/j.1747- 0803.2012.00705.x
  16. del Castillo SL, McCulley ME, Khemani RG, Jeffries HE, Thomas DW, Peregrine J, et al. Reducing the incidence of necrotizing enterocolitis in neonates with hypoplastic left heart syndrome with the introduction of an enteral feed protocol. Pediatric Critical Care Medicine. 2010;11(3):373-377. http://dx.doi.org/10.1097/ PCC.0b013e3181c01475
  17. Braudis NJ, Curley MA, Beaupre K, Thomas KC, Hardiman G, Laussen P, et al. Enteral feeding algorithm for infants with hypoplastic left heart syndrome poststage I palliation. Pediatric Critical Care Medicine. 2009;10(4):460-466. http://dx.doi.org/10.1097/ PCC.0b013e318198b167
  18. Davis D, Davis S, Cotman K, Worley S, Londrico D, Kenny D, et al. Feeding difficulties and growth delay in children with hypoplastic left heart syndrome versus d-transposition of the great arteries. Pediatric Cardiology. 2008;29(2):328-333. http://dx.doi.org/10.1007/s00246-007-9027-9
  19. Gaies MG GJ, Yen AH, Napoli ML, Gajarski RJ, Ohye RG, Charpie JR, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatric Critical Care Medicine. 2010;11(2):234-238. https://doi.org/10.1097/PCC.0b013e3181b806fc
  20. Petrillo-Albarano T, Pettignano R, Asfaw M, Easely K. Use of a feeding protocol to improve nutritional support through early, aggressive, enteral nutrition in the pediatric intensive care unit. Pediatric Critical Care Medicine. 2006;7(4):340-344. https://doi.org/10.1097/01.PCC.0000225371.10446.8F
  21. Moore TA, Wilson ME. Feeding intolerance: a concept analysis. Advances in Neonatal Care. 2011;11(3):149-154. http://dx.doi. org/10.1097/ANC.0b013e31821ba28e
  22. NHS. NHS Institute for Innovation and Improvement. Protocol based care [Internet]. UK: NHS; 2010 [cited 2015 Feb 1]. Available from: http://www.institute.nhs.uk/quality'and'service'improvement'tools/quality'and'service'improvement'tools/protocol'based'care.html.
  23. Park MS. A study on development of a protocol for operating room infection control nursing [Unpublished master's thesis]. Seoul: Korea University; 2011.
  24. Yoshimura S, Miyazu M, Yoshizawa S, So M, Kusama N, Hirate H, et al. Efficacy of an enteral feeding protocol for providing nutritional support after paediatric cardiac surgery. Anaesthesia and Intensive Care. 2015;43(5):587-593.
  25. Jenkins E. Feeding protocols for neonates with hypoplastic left heart syndrome: A review. AACN Advanced Critical Care. 2015;26(3):215-221. http://dx.doi.org/10.1097/nci.0000000000000096
  26. King W, Petrillo T, Pettignano R. Enteral nutrition and cardiovascular medications in the pediatric intensive care unit. Journal of Parenteral and Enteral Nutrition. 2004;28(5):334-338. https://doi.org/10.1177/0148607104028005334
  27. Leutert K, Kench A, Mitchell A, Schell D, Festa M. Development and implementation of a feeding algorithm to optimise nutrition in Paediatric Intensive Care. Australian Critical Care. 2015;28(1):45. http:// dx.doi.org/10.1016/j.aucc.2014.10.020
  28. Thiagarajan RR, Bird GL, Harrington K, Charpie JR, Ohye RC, Steven JM, et al. Improving safety for children with cardiac disease. Cardiology in the Young. 2007;17 (Suppl 2):127-132. http://dx.doi.org/10.1017/S1047951107001230
  29. Rodriguez L. Nutritional status: assessing and understanding its value in the critical care setting. Critical Care Nursing Clinics of North America. 2004;16(4):509-514. https://doi.org/10.1016/S0899-5885(04)00069-3
  30. Jonas RA. Comprehensive surgical management of congenital heart disese. 2nd ed. Boca Raton, FL: CRC Press; 2014. p. 90-91.

Cited by

  1. 학교보건 실무 프로토콜 개발: 초등학교를 대상으로 vol.32, pp.3, 2016, https://doi.org/10.15434/kssh.2019.32.3.152