Standardized feeding pathway improves documentation and alert adherence in postoperative CHD infants

This single-center quality improvement cohort study evaluated the impact of implementing a standardized feeding-tolerance management pathway in postoperative congenital heart disease infants. The study included 301 infants (148 pre-implementation in 2022; 153 post-implementation) and compared outcomes before and after unit-wide standardization of feeding intolerance risk assessment, enteral nutrition monitoring indicators, alert-trigger criteria, and documentation procedures.

Post-implementation, documentation completeness increased from 68.4% to 91.7% (P < 0.001), and adherence to predefined alert criteria rose from 54.7% to 92.2% (P < 0.001). The study's primary outcome was feeding intolerance incidence, but results for this measure were not reported in the available abstract. Secondary outcomes included time to full enteral nutrition, gastrointestinal symptoms, enteral nutrition interruptions, and nutritional status, though specific results for these endpoints were not provided.

Safety and tolerability data were not reported. The study has several important limitations: it was a single-center, observational pre-post design that cannot establish causality, and generalizability to other settings is uncertain. The abstract did not report results for the primary outcome of feeding intolerance incidence, nor did it provide effect sizes for the process improvements observed.

For clinical practice, this study suggests that implementing standardized feeding protocols may improve process measures like documentation and alert adherence in this vulnerable population. However, the lack of reported primary outcome data and the observational nature of the evidence mean clinicians should interpret these findings cautiously while awaiting more complete reporting of clinical outcomes.