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American Journal of Critical Care. 2009;18: 52-57 doi:10.4037/ajcc2009405
Copyright © 2009 by the American Association of Critical-Care Nurses.
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Enteral Feeding and Caloric Intake in Neonates After Cardiac Surgery

By Courtney R. Schwalbe-Terilli, RN, BSN, Diane H. Hartman, RN, BSN, Monica L. Nagle, RD, Paul R. Gallagher, MA, Richard F. Ittenbach, PhD, Nancy B. Burnham, RN, CRNP, J. William Gaynor, MD and Chitra Ravishankar, MD. Courtney R. Schwalbe-Terilli and Diane H. Hartman are nurses, Nancy B. Burnham is a nurse practitioner, and J. William Gaynor is a surgeon in the Department of Cardiothoracic Surgery, Monica L. Nagle is a dietitian in the Department of Clinical Nutrition, Paul R. Gallagher is a statistician at the Biostatistics and Data Management Core, and Chitra Ravishankar is a physician in the Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, The University of Pennsylvania School of Medicine. Richard F. Ittenbach is a statistician at the Center for Epidemiology and Biostatistics at Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio.

Corresponding author: Courtney R. Schwalbe-Terilli, RN, BSN, New York Medical College, Center for Hypotension, 19 Bradhurst Ave, Ste 1600 South, Hawthorne, NY 10532 (e-mail: cschwalbe{at}hotmail.com).

Background Adequate enteral nutrition may be difficult to achieve early in neonates after cardiac surgery, but it is essential for growth, wound healing, and immune function.

Objective To assess caloric intake in neonates receiving enteral nutrition after surgery.

Methods A retrospective chart review was conducted of daily enteral caloric intake in the cardiac intensive care unit of a tertiary children’s hospital. Data on the institution of enteral feeding and the discontinuation of parenteral nutrition were assessed for full-term neonates who had undergone cardiac surgery.

Results Caloric intake was assessed in 100 patients, 52 with biventricular cardiac defects and 48 with a functional single ventricle. The median duration of stay in the cardiac intensive care unit was 13 days (range, 4–69), and patients received enteral feeding exclusively for a median of 5 days (range, 1–43). In total, 705 patient days were evaluated. The median caloric intake per day was 93 kcal/kg (range, 43–142). A goal of 100 kcal/kg was achieved for 48.4% of patient days and 120 kcal/kg for only 19.7% of patient days. Median weight change for the period of enteral feeding was –20 g (range, –775 to 1485 g).

Conclusions Enteral feeding alone is often suboptimal after neonatal cardiac surgery. New strategies to improve caloric intake may enhance postoperative recovery.


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Copyright © 2009 by the American Association of Critical-Care Nurses.