Incidence of Necrotizing Enterocolitis and Improvement in Growth Using a Standardized Cardiac Feeding Guideline

Background.Necrotizing enterocolitis (NEC) is a gastrointestinal infection with high morbidity and mortality in the neonatal period. Ductal dependent congenital heart disease (CHD) is considered a significant risk factor for developing NEC in both term and preterm infants. These infants are also at risk for weak growth and malnutrition. Due to this increased risk, many institutions have implemented strict feeding guidelines for these infants with documented success in reducing the incidence of NEC and improving overall growth. The purpose of this project was to identify whether an implemented standardized cardiac feeding guideline reduced the incidence of NEC and improved overall growth in infants with ductal dependent CHD.Method.A retrospective review of patient records both pre and post implementation of the cardiac feeding guideline was conducted. The time frame for the review was 2006-2019. Available databases and patient lists were queried to identify patients with eight defined cardiac diagnoses. The primary outcomes evaluated were overall growth including weight, length, and occipitofrontal circumference (OFC), and incidence of NEC pre and post guideline implementation. Variance analysis was also done to evaluate the effect of the guideline on outcomes. Secondary outcomes evaluated were bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and cholestasis. Results.Five (10.2%) out of 49 infants were diagnosed with NEC pre implementation; seven (8.4%) out of 83 were diagnosed post implementation (p= .078). Average growth (g/day) was similar pre-implementation (M= 11.23, SD= 17) and post implementation (M= 11.95, SD= 12.43), p= .61. Overall length gain (cm/week) pre implementation (M= 0.26, SD= 1.19) was similar when compared to post implementation (M= 0.7, SD= 1), p= .108. Overall OFC growth (cm/week) was similar the post implementation group (M= 0.33, SD = 0.055) when compared to the pre-implementation group (M= 0.16, SD= 0.129), p= .16. There was a significant difference in those infant's fed via feeding guidelines vs those never fed for both OFC, F(3, 81) = 4.028, p= .01, and length, F(3, 81) = 3.99, p= .011. Conclusion.Our findings show that there was no significant difference in the overall incidence of NEC for infants fed using the cardiac feeding guideline. Length and OFC gain were improved in the cohort groups that were fed using the guidelines vs. those who were never fed. There were no statistically significant findings for the secondary outcomes.