Table 1_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.docx

BackgroundInfants recovering from congenital heart disease (CHD) surgery frequently experience feeding intolerance (FI), a major barrier to achieving adequate enteral nutrition (EN). This pre–post quality improvement study evaluated whether implementation of a standardized feeding-tolerance management pathway was associated with improved consistency of EN monitoring and corresponding trends in FI-related outcomes.
MethodsA single-center, consecutively enrolled quality improvement cohort included postoperative CHD infants admitted in 2022 (pre-implementation) and 2023 (post-implementation). The intervention consisted of unit-wide standardization of FI risk assessment, EN monitoring indicators, alert-trigger criteria, and documentation procedures. No feeding strategy was altered. The primary outcome was FI incidence; secondary outcomes included time to full EN, gastrointestinal symptoms, EN interruptions, and nutritional status. Statistical analyses included χ2 tests, logistic regression, Cox models, and negative binomial regression.
ResultsA total of 301 infants were analyzed (148 pre-implementation; 153 post-implementation). Documentation completeness increased from 68.4% to 91.7%, and adherence to predefined alert criteria rose from 54.7% to 92.2% (both P < 0.001). FI incidence decreased from 42.6% to 24.2% (RR 0.57, 95% CI 0.41–0.79), and adjusted odds of FI remained lower post-implementation (aOR 0.48, 95% CI 0.29–0.79). Time to full EN was shorter (median 9 to 6 days; HR 1.48, 95% CI 1.11–1.97). Gastrointestinal symptom burden and GI-related feeding interruptions were reduced, while nutritional decline was attenuated, reflected by improved weight-for-age z score (WAZ) change (ΔWAZ −0.22 to −0.04; P = 0.004). Subgroup and sensitivity analyses demonstrated consistent directional trends.
ConclusionsImplementation of a standardized feeding-tolerance pathway was associated with improved monitoring consistency and favorable trends in FI incidence, EN progression, and in-hospital nutritional stability among postoperative CHD infants.