Postoperative Enteral Nutrition Guidelines Reduce the Risk of Intestinal Failure-Associated Liver Disease in Surgical Infants

Research output: Contribution to journalArticle

Abstract

Objective: To assess the effectiveness of postoperative feeding guidelines in reducing the incidence and severity of intestinal failure-associated liver disease (IFALD) among infants. Study design: Two cohorts of infants <6 months old undergoing intestinal surgery were compared: preguideline (retrospective data from 2007 to 2013; n = 83) and postguideline (prospective data from 2013 to 2016; n = 81). The guidelines included greater initial enteral nutrition volumes of 20 mL/kg/d and daily feeding advancement if tolerated. The primary outcomes were incidence of IFALD (peak direct bilirubin [DB] >2 mg/dL) and severity (DB >5 mg/dL for moderate-severe). Multiple logistic regression was used to determine the odds of developing IFALD. Other outcomes were time to reach 50% and 100% goal calories from enteral nutrition and the incidence of necrotizing enterocolitis after feeding. Results: The incidence of IFALD decreased from 71% to 51% (P = .031), and median peak DB decreased from 5.7 to 2.4 mg/dL (P = .001). After adjusting for diagnosis and prematurity, the odds of developing IFALD of any severity were reduced by 60% (OR 0.40, 95% CI 0.20-0.85), and the odds of developing moderate-to-severe IFALD were reduced by 72% (OR 0.28, 95% CI 0.13-0.58) with guideline use. Time to reach 50% enteral nutrition decreased from a median of 10 to 6 days (P = .020) and time to reach 100% enteral nutrition decreased from 35 to 21 days (P = .035) with guideline use. The incidence of necrotizing enterocolitis after initiating enteral nutrition did not change (5% vs 9%, P = .346). Conclusions: Implementation of feeding guidelines reduced time to reach feeding goals, significantly reducing IFALD incidence and severity.

Original languageEnglish (US)
JournalJournal of Pediatrics
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Nutrition Policy
Enteral Nutrition
Liver Diseases
Guidelines
Incidence
Necrotizing Enterocolitis
Logistic Models

Keywords

  • Atresia
  • Cholestasis
  • Feeding protocol
  • Gastroschisis
  • Necrotizing enterocolitis
  • Short bowel syndrome

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

@article{1f497446d2fd4bf3ac1d0b27f55eb97d,
title = "Postoperative Enteral Nutrition Guidelines Reduce the Risk of Intestinal Failure-Associated Liver Disease in Surgical Infants",
abstract = "Objective: To assess the effectiveness of postoperative feeding guidelines in reducing the incidence and severity of intestinal failure-associated liver disease (IFALD) among infants. Study design: Two cohorts of infants <6 months old undergoing intestinal surgery were compared: preguideline (retrospective data from 2007 to 2013; n = 83) and postguideline (prospective data from 2013 to 2016; n = 81). The guidelines included greater initial enteral nutrition volumes of 20 mL/kg/d and daily feeding advancement if tolerated. The primary outcomes were incidence of IFALD (peak direct bilirubin [DB] >2 mg/dL) and severity (DB >5 mg/dL for moderate-severe). Multiple logistic regression was used to determine the odds of developing IFALD. Other outcomes were time to reach 50{\%} and 100{\%} goal calories from enteral nutrition and the incidence of necrotizing enterocolitis after feeding. Results: The incidence of IFALD decreased from 71{\%} to 51{\%} (P = .031), and median peak DB decreased from 5.7 to 2.4 mg/dL (P = .001). After adjusting for diagnosis and prematurity, the odds of developing IFALD of any severity were reduced by 60{\%} (OR 0.40, 95{\%} CI 0.20-0.85), and the odds of developing moderate-to-severe IFALD were reduced by 72{\%} (OR 0.28, 95{\%} CI 0.13-0.58) with guideline use. Time to reach 50{\%} enteral nutrition decreased from a median of 10 to 6 days (P = .020) and time to reach 100{\%} enteral nutrition decreased from 35 to 21 days (P = .035) with guideline use. The incidence of necrotizing enterocolitis after initiating enteral nutrition did not change (5{\%} vs 9{\%}, P = .346). Conclusions: Implementation of feeding guidelines reduced time to reach feeding goals, significantly reducing IFALD incidence and severity.",
keywords = "Atresia, Cholestasis, Feeding protocol, Gastroschisis, Necrotizing enterocolitis, Short bowel syndrome",
author = "Shores, {Darla R} and Alaish, {Samuel M.} and Aucott, {Susan W} and Janine Bullard and Courtney Haney and Heidi Tymann and Nonyane, {Bareng A.S.} and Kathleen Schwarz",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.jpeds.2017.11.058",
language = "English (US)",
journal = "Journal of Pediatrics",
issn = "0022-3476",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Postoperative Enteral Nutrition Guidelines Reduce the Risk of Intestinal Failure-Associated Liver Disease in Surgical Infants

AU - Shores, Darla R

AU - Alaish, Samuel M.

AU - Aucott, Susan W

AU - Bullard, Janine

AU - Haney, Courtney

AU - Tymann, Heidi

AU - Nonyane, Bareng A.S.

AU - Schwarz, Kathleen

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: To assess the effectiveness of postoperative feeding guidelines in reducing the incidence and severity of intestinal failure-associated liver disease (IFALD) among infants. Study design: Two cohorts of infants <6 months old undergoing intestinal surgery were compared: preguideline (retrospective data from 2007 to 2013; n = 83) and postguideline (prospective data from 2013 to 2016; n = 81). The guidelines included greater initial enteral nutrition volumes of 20 mL/kg/d and daily feeding advancement if tolerated. The primary outcomes were incidence of IFALD (peak direct bilirubin [DB] >2 mg/dL) and severity (DB >5 mg/dL for moderate-severe). Multiple logistic regression was used to determine the odds of developing IFALD. Other outcomes were time to reach 50% and 100% goal calories from enteral nutrition and the incidence of necrotizing enterocolitis after feeding. Results: The incidence of IFALD decreased from 71% to 51% (P = .031), and median peak DB decreased from 5.7 to 2.4 mg/dL (P = .001). After adjusting for diagnosis and prematurity, the odds of developing IFALD of any severity were reduced by 60% (OR 0.40, 95% CI 0.20-0.85), and the odds of developing moderate-to-severe IFALD were reduced by 72% (OR 0.28, 95% CI 0.13-0.58) with guideline use. Time to reach 50% enteral nutrition decreased from a median of 10 to 6 days (P = .020) and time to reach 100% enteral nutrition decreased from 35 to 21 days (P = .035) with guideline use. The incidence of necrotizing enterocolitis after initiating enteral nutrition did not change (5% vs 9%, P = .346). Conclusions: Implementation of feeding guidelines reduced time to reach feeding goals, significantly reducing IFALD incidence and severity.

AB - Objective: To assess the effectiveness of postoperative feeding guidelines in reducing the incidence and severity of intestinal failure-associated liver disease (IFALD) among infants. Study design: Two cohorts of infants <6 months old undergoing intestinal surgery were compared: preguideline (retrospective data from 2007 to 2013; n = 83) and postguideline (prospective data from 2013 to 2016; n = 81). The guidelines included greater initial enteral nutrition volumes of 20 mL/kg/d and daily feeding advancement if tolerated. The primary outcomes were incidence of IFALD (peak direct bilirubin [DB] >2 mg/dL) and severity (DB >5 mg/dL for moderate-severe). Multiple logistic regression was used to determine the odds of developing IFALD. Other outcomes were time to reach 50% and 100% goal calories from enteral nutrition and the incidence of necrotizing enterocolitis after feeding. Results: The incidence of IFALD decreased from 71% to 51% (P = .031), and median peak DB decreased from 5.7 to 2.4 mg/dL (P = .001). After adjusting for diagnosis and prematurity, the odds of developing IFALD of any severity were reduced by 60% (OR 0.40, 95% CI 0.20-0.85), and the odds of developing moderate-to-severe IFALD were reduced by 72% (OR 0.28, 95% CI 0.13-0.58) with guideline use. Time to reach 50% enteral nutrition decreased from a median of 10 to 6 days (P = .020) and time to reach 100% enteral nutrition decreased from 35 to 21 days (P = .035) with guideline use. The incidence of necrotizing enterocolitis after initiating enteral nutrition did not change (5% vs 9%, P = .346). Conclusions: Implementation of feeding guidelines reduced time to reach feeding goals, significantly reducing IFALD incidence and severity.

KW - Atresia

KW - Cholestasis

KW - Feeding protocol

KW - Gastroschisis

KW - Necrotizing enterocolitis

KW - Short bowel syndrome

UR - http://www.scopus.com/inward/record.url?scp=85041355511&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85041355511&partnerID=8YFLogxK

U2 - 10.1016/j.jpeds.2017.11.058

DO - 10.1016/j.jpeds.2017.11.058

M3 - Article

C2 - 29402454

AN - SCOPUS:85041355511

JO - Journal of Pediatrics

JF - Journal of Pediatrics

SN - 0022-3476

ER -