Nutrition and Mesenteric Issues in Pediatric Cardiac Critical Care

Floh, Alejandro A.; Slicker, Julie; Schwartz, Steven M.

doi:10.1097/pcc.0000000000000801

Cited by 19 publications

(15 citation statements)

References 66 publications

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“…In our study, nurses main cited reasons for impaired enteral feeding in the ICU were consistent with what others have found in terms of fluid restriction (Tume et al ., ; Floh et al ., ) and fasting for procedures (Bockenkamp et al ., ; Mehta et al ., ). It was notable, however, that nurses themselves perceived that inadequate knowledge, education and attitudes impacted enteral feeding.…”

Section: Discussionmentioning

confidence: 99%

Paediatric intensive care nurses' decision‐making around gastric residual volume measurement

Tume

Latten

Kenworthy

2017

Nursing in Critical Care

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BackgroundMeasuring gastric residual volume (GRV) to guide enteral feeding is a common nursing practice in intensive care units, yet little evidence supports this practice. In addition, this practice has been shown to potentially contribute to inadequate energy delivery in intensive care, which remains a problem in critically ill children.. AimsWe aimed to explore paediatric intensive care nurses' decision-making surrounding this practice. MethodsA cross-sectional electronic survey in a single mixed general and cardiac surgical PICU in the UK. ResultsThe response rate was 59% (91/154) and responding nurses were experienced, with a mean PICU experience of 10.5 years (SD 8.09). The three main reasons for stopping or withholding enteral feeds were: the volume of gastric residual volume obtained (67%), the appearance of this gastric aspirate (40%) and the overall clinical condition of the child (23%). Most 2 nurses reported checking GRV primarily to determine 'feed tolerance' (97%) as well as confirming feeding tube position (94%). Nurses' perceived harms from high GRV were: the risk of pulmonary aspiration (44%), malabsorption of feeds (20%) and the risk of vomiting (19%). GRV was measured frequently in this PICU, with 58% measuring GRV before every feed, 27% measuring 4 hourly and 17% measuring 6 hourly.The majority of nurses (84%) stated they would be worried or very worried if they could not measure GRV routinely. ConclusionsPICU nurses' decision-making surrounding initiating and withholding enteral feeds, and determining 'feed tolerance' remains heavily based on GRV. PICU nurses' have significant fears around patient harm if they do not measure GRV routinely. Relevance to clinical practiceThis nursing practice is likely to be one of the factors that impair the delivery of enteral nutrition in critically ill children and as such its validity and usefulness needs to be challenged and studied in future research.

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Section: Discussionmentioning

confidence: 99%

Paediatric intensive care nurses' decision‐making around gastric residual volume measurement

Tume

Latten

Kenworthy

2017

Nursing in Critical Care

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“…Chyle is high in protein and the loss of chyle during early treatment of chylothorax may further increase protein requirements [32,33]. Although protein requirements of cardiac infants have not been directly assessed, it is estimated that 2.0e3.5 g/kg/day of protein is required [34,35]. In this study, all infants met or exceeded these estimated protein requirements with intakes ranging from 2.3 to 3.8 g/kg/day of protein.…”

Section: Discussionmentioning

confidence: 73%

Growth of cardiac infants with post-surgical chylothorax can be supported using modified fat breast milk with proactive nutrient-enrichment and advancement feeding protocols; an open-label trial

DiLauro

Russell

McCrindle

et al. 2020

Clinical Nutrition ESPEN

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Background & aim: Previously we showed that modified fat breast milk (MFBM) facilitated resolution of post-surgical chylothorax in cardiac infants, but their weight-forage and length-forage z-scores declined over the !6-week treatment duration. Our aim was to evaluate the growth of infants diagnosed with post-surgical chylothorax and fed according to one of two proactive feeding protocols using MFBM or a high medium triglyceride (MCT)-containing formula (standard of care). Methods: In this open-label trial, infants who were receiving >50% of their enteral feeds as breast milk prior to chylothorax diagnosis were randomized to receive their enteral feeds according to one of two proactive MFBM protocols: Target Fortification (n ¼ 8), where the protein concentration of defatted breast milk was measured weekly and multi-and single-nutrient modulars were added to provide 3.5 g/kg/day of protein; or Higher Initial Concentration (n ¼ 8), where defatted breast milk was initially fortified to an energy and nutrient level higher than that of unmodified breast milk (80kcal/100 ml; 2.2 g/100 ml protein). A third nonrandomized group of infants (n ¼ 8) received high MCT formula (68kcal/100 ml; 2.3 g/100 ml protein). The intervention lasted for a minimum of 6-weeks after chest tube removal and continued after discharge. Weekly weight, length and head circumference (HC) measurements were completed. Results: At enrolment, there was no statistically significant differences in mean (±SD) weight-forage (À1.6 ± 0.9, n ¼ 24), length-forage (À1.3 ± 0.8), or HC-forage (À0.9 ± 1.0) z-scores among groups. Changes in mean weight-(À0.3 ± 0.9, n ¼ 23), length-(0.1 ± 0.6) and HC-forage (0.2 ± 0.6) z-scores did not differ among groups over the treatment period. There was no difference in duration or volume of chest tube drainage across groups. Conclusion: Use of proactive MFBM feeding protocols both resolve chylothorax and support growth in infants following cardiothoracic surgery. Trial registration: ClinicalTrials.gov (NCT02577419).

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“…Infants with CHD often have a higher risk for feeding intolerance . In addition, 4.2% of CHD infants may have a comorbidity of structural gastrointestinal anomalies, making nutrition supply more complex. As a result, poor nutrition is 1 of the most common comorbidities in infants with CHD .…”

Section: Preoperative Poor Nutrition Statusmentioning

confidence: 99%

Energy and Protein Requirements in Children Undergoing Cardiopulmonary Bypass Surgery: Current Problems and Future Direction

Zhang

Cui

et al. 2018

J Parenter Enteral Nutr

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Congenital heart disease (CHD) is 1 of the most common congenital malformations, and considerable numbers of infants and young children with CHD undergo cardiopulmonary bypass surgery. It has been increasingly realized that perioperative nutrition support plays an important role in improving clinical outcomes. The purpose of this review, by searching PubMed, was to examine the nutrition conditions in perioperative children with CHD and the main problems in nutrition management in the cardiac intensive care unit (CICU), based on which future directions were proposed. We found that preoperative poor nutrition status is common. This limited reserve of energy and protein is further compounded by the complex metabolic alterations with hypermetabolism, hypercatabolism, and hypoanabolism in the early postoperative course. Knowledge about energy and protein metabolism and requirements in children after cardiopulmonary bypass remains very limited. The current nutrition recommendations in the CICU are based on little evidence. Insufficient energy and protein supply to meet demands remains a norm in the immediate postoperative period. The commonly used predictive equations do not provide accurate estimate of energy requirement in individual patients during the highly dynamic postoperative course. Indirect calorimetry can provide the best estimate of energy requirements for children with CHD in the CICU. Measurement of nitrogen balance is the recommended method to determine the minimal protein requirement. During the early postoperative period, daily measurements of resting energy expenditure using indirect calorimetry and nitrogen balance in each individual child are essential to optimize energy and protein supply to meet requirements.

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Nutrition and Mesenteric Issues in Pediatric Cardiac Critical Care

Cited by 19 publications

References 66 publications

Paediatric intensive care nurses' decision‐making around gastric residual volume measurement

Paediatric intensive care nurses' decision‐making around gastric residual volume measurement

Growth of cardiac infants with post-surgical chylothorax can be supported using modified fat breast milk with proactive nutrient-enrichment and advancement feeding protocols; an open-label trial

Energy and Protein Requirements in Children Undergoing Cardiopulmonary Bypass Surgery: Current Problems and Future Direction

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