Darla R Shores1, Samuel M Alaish2, Susan W Aucott3, Janine E Bullard3, Courtney Haney4, Heidi Tymann4, Bareng A S Nonyane5, Kathleen B Schwarz4. 1. Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD. Electronic address: dshores1@jhmi.edu. 2. Department of General Pediatric Surgery, Johns Hopkins School of Medicine, Baltimore, MD. 3. Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD. 4. Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD. 5. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
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.
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.
Authors: D J Andorsky; D P Lund; C W Lillehei; T Jaksic; J Dicanzio; D S Richardson; S B Collier; C Lo; C Duggan Journal: J Pediatr Date: 2001-07 Impact factor: 4.406
Authors: Christopher W Snyder; Christopher W Synder; Joseph R Biggio; Phillip Brinson; Leandra A Barnes; Donna T Bartle; Keith E Georgeson; Oliver J Muensterer Journal: J Pediatr Surg Date: 2011-01 Impact factor: 2.545
Authors: Julie Slicker; David A Hehir; Megan Horsley; Jessica Monczka; Kenan W Stern; Brandis Roman; Elena C Ocampo; Liz Flanagan; Erin Keenan; Linda M Lambert; Denise Davis; Marcy Lamonica; Nancy Rollison; Haleh Heydarian; Jeffrey B Anderson Journal: Congenit Heart Dis Date: 2012-08-14 Impact factor: 2.007
Authors: Alison Leaf; Jon Dorling; Stephen Kempley; Kenny McCormick; Paul Mannix; Louise Linsell; Edmund Juszczak; Peter Brocklehurst Journal: Pediatrics Date: 2012-04-09 Impact factor: 7.124
Authors: Theresa C Willis; Beth A Carter; Stefanie P Rogers; Keli M Hawthorne; Penni D Hicks; Steven A Abrams Journal: JPEN J Parenter Enteral Nutr Date: 2009-07-08 Impact factor: 4.016
Authors: Robert H Squires; Christopher Duggan; Daniel H Teitelbaum; Paul W Wales; Jane Balint; Robert Venick; Susan Rhee; Debra Sudan; David Mercer; J Andres Martinez; Beth A Carter; Jason Soden; Simon Horslen; Jeffrey A Rudolph; Samuel Kocoshis; Riccardo Superina; Sharon Lawlor; Tamara Haller; Marcia Kurs-Lasky; Steven H Belle Journal: J Pediatr Date: 2012-05-11 Impact factor: 4.406