Implementation of standardized feeding pathways for infants with gastroschisis to improve patient outcomes: A quality improvement project in a level IV surgical NICU.

IF 2.1 4区 医学 Q3 NUTRITION & DIETETICS Nutrition in Clinical Practice Pub Date : 2024-09-25 DOI:10.1002/ncp.11216
Andrea Adler, Kadakkal Radhakrishnan, Natalie Yeaney
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Abstract

Gastroschisis is a leading cause of pediatric intestinal failure. Feeding guidelines may lead to improved patient outcomes including decreased time to reach full feeds, a reduction in the duration of parenteral nutrition, and reduced length of stay. However, there is limited evidence on what the ideal feeding guidelines are for this complex gastrointestinal diagnosis. In this quality improvement project, after completing a literature review, we created three pathways based on the complexity of the gastroschisis. We reviewed historical data without a defined feeding pathway/guideline to our newly created pathways in the intervention group. The study included 35 patients with varying degrees of gastroschisis complexity, consisting of 9 current patients (October 2021-December 2022) who were provided with defined feeding pathways and 26 historical patients before the protocol was implemented (January 2015-August 2021). There were no significant differences in the number of days required for full feeds between the two groups. However, the mean duration of parenteral nutrition was 18.9 days (95% CI, -31.8 to -7.0) shorter in the intervention group. Although not statistically significant, the patients in the intervention group had a mean length of stay that was 13.1 days (95% CI, -50.0 to 25.4) shorter than the historical group. The creation of standardized feeding guidelines for the gastroschisis population resulted in a statistically nonsignificant decrease in time to reach full enteral feeds, a statistically significant reduced duration of parenteral nutrition, and a statistically nonsignifiant decreased length of stay.

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为患有胃裂的婴儿实施标准化喂养路径,以改善患者预后:四级手术新生儿重症监护室的质量改进项目。
胃裂是导致小儿肠道功能衰竭的主要原因。喂养指南可改善患者的治疗效果,包括缩短达到完全喂养的时间、缩短肠外营养的持续时间和缩短住院时间。然而,对于这种复杂的胃肠道疾病,理想的喂养指南是什么,目前证据还很有限。在这个质量改进项目中,在完成文献回顾后,我们根据胃裂的复杂程度创建了三种路径。我们回顾了干预组中没有明确喂养路径/指南的历史数据,以及我们新创建的路径。该研究纳入了35名具有不同程度胃裂复杂性的患者,其中包括9名目前(2021年10月至2022年12月)已获得明确喂养路径的患者和26名协议实施前(2015年1月至2021年8月)的历史患者。两组患者完全进食所需的天数没有明显差异。但是,干预组的肠外营养平均持续时间缩短了 18.9 天(95% CI,-31.8 到 -7.0)。干预组患者的平均住院时间比历史组缩短了 13.1 天(95% CI,-50.0 到 25.4),尽管没有统计学意义。为胃十二指肠畸形患者制定标准化喂养指南后,达到完全肠内喂养的时间在统计学上无显著性差异,肠外营养的持续时间在统计学上有显著性差异,住院时间在统计学上无显著性差异。
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来源期刊
CiteScore
6.00
自引率
9.70%
发文量
128
审稿时长
3 months
期刊介绍: NCP is a peer-reviewed, interdisciplinary publication that publishes articles about the scientific basis and clinical application of nutrition and nutrition support. NCP contains comprehensive reviews, clinical research, case observations, and other types of papers written by experts in the field of nutrition and health care practitioners involved in the delivery of specialized nutrition support. This journal is a member of the Committee on Publication Ethics (COPE).
期刊最新文献
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