Impact of a unit-wide feeding tolerance management protocol on enteral feeding outcomes in infants with congenital heart disease: a pre-post quality improvement cohort study.
Yaqin Xiao, Yanhua Wang, Jingpu Gao and 3 others
PMID 41970934WHAT IT FOUND
After a unit-wide feeding-tolerance pathway, feeding intolerance was lower in infants after congenital heart surgery: 42.57% before and 24.18% after.
Full feeding took a median of 9.00 days before and 6.00 days after.
Key findings
01Feeding intolerance was 42.57% in the pre-implementation cohort and 24.18% in the post-implementation cohort.
02Feeding-tolerance risk assessment completion rose from 48.65% to 90.85%, and enteral nutrition documentation completeness rose from 68.42% to 91.73%.
03Median time to full enteral feeding was 9.00 days before implementation and 6.00 days after implementation.
STILL TO COME
How it was doneWhat they found
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What it does not show
It was done in one cardiac intensive care unit, so other units may not get the same result if staffing, workflow, or records differ. It compared two time periods without randomisation or a control group, so it shows association, not proof that the pathway caused the improvements. Feeding intolerance was judged from nursing records, and the definition depended on documentation quality, so missed or ambiguous entries could affect results. Medical teams still decided feeding type, formula, and when to start or advance feeds, so differences in those decisions may have contributed. The study excluded infants with incomplete feeding records or certain gastrointestinal conditions, so it does not cover all postoperative cardiac infants. Longer-term nutrition after discharge was not measured. No correction for multiple comparisons was applied.
Declared interests
The paper states that financial support was received for the work or publication. The funding source is the Medical Science Research Project of Hebei Province, grant number 20240756, on nursing strategies for perioperative enteral nutrition intolerance in children with congenital heart disease. The text does not report commercial conflicts of interest.
The easy way to misread this
Do not read the lower feeding-intolerance rate as proof that the pathway caused better outcomes. The study was a single-center before-and-after quality improvement analysis without randomisation, and medical feeding decisions were not controlled, so other changes could explain the pattern.
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