• Jon Kaufman, Piyagarnt Vichayavilas, Michael Rannie, Christine Peyton, Esther Carpenter, Danielle Hull, Jennifer Alpern, Cindy Barrett, Eduardo M da Cruz, and Genie Roosevelt.
• The Heart Institute at Children's Hospital Colorado, Department of Pediatrics, jonathan.kaufman@childrenscolorado.org.
• Pediatrics. 2015 Mar 1; 135 (3): e717-25.

BackgroundThis initiative sought to improve nutrition delivery in critically ill children with heart disease admitted to the cardiac ICU (CICU) and neonates undergoing stage 1 palliation (S1P) for single-ventricle physiology through interdisciplinary team interventions. Specific goals were increased caloric and protein delivery for all patients and a more nourished state for infants with single ventricles at the time of discharge.MethodsWe developed a nutrition flow sheet in the electronic health record to track whether daily nutrition goals were met. Interventions included nurses reporting daily whether caloric and protein goals were met, mandatory involvement of feeding specialists, and introduction of an enteral nutrition guideline. For infants undergoing S1P, weight-for-age z score (as an indicator for assessing malnutrition) was calculated at admission and discharge.ResultsThe percentage of patient days per month when daily caloric goals were met increased from 50.1% to 60.7%, and protein goals met increased from 51.6% to 72.7%. Hospital length of stay, need for ventilation, and mortality did not differ. Patients undergoing S1P demonstrated a statistically significant improvement in weight-for-age z score compared with the preintervention group (P = .003). Thirteen S1P patients were discharged undernourished in the preintervention group; 5 were severely undernourished. In the intervention group, 4 patients were discharged undernourished, and none were severely undernourished.ConclusionsThis initiative resulted in improved nutrition delivery for a heterogeneous population of cardiac patients in the CICU as well as significant improvements in weight gain and nourishment status at discharge in infants undergoing S1P.Copyright © 2015 by the American Academy of Pediatrics.

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