Shores DR, et al. - The effectiveness of postoperative feeding guidelines in reducing the incidence and severity of intestinal failure–associated liver disease (IFALD) among infants was determined. Implementation of feeding guidelines resulted in a reduction in time to reach feeding goals, thereby significantly reducing the incidence and severity of IFALD.

Methods

• Researchers performed a comparison of two cohorts of infants <6 months old undergoing intestinal surgery: preguideline (retrospective data from 2007 to 2013; n = 83) and postguideline (prospective data from 2013 to 2016; n = 81).
• Greater initial enteral nutrition volumes of 20 mL/kg/d and daily feeding advancement if tolerated were included in guidelines.
• Incidence of IFALD (peak direct bilirubin [DB] >2 mg/dL) and severity (DB >5 mg/dL for moderate-severe) were the primary outcomes assessed.
• They used multiple logistic regression to ascertain the odds of developing IFALD.
• Time to reach 50% and 100% goal calories from enteral nutrition and the incidence of necrotizing enterocolitis after feeding were the other assessed outcomes.

Results

• A decrease in the incidence of IFALD from 71% to 51% (P=.031), and in median peak DB from 5.7 to 2.4 mg/dL (P=.001) was noticed.
• With guideline use, a reduction in the odds of developing IFALD of any severity by 60% (OR 0.40, 95% CI 0.20-0.85), and in the odds of developing moderate-to-severe IFALD by 72% (OR 0.28, 95% CI 0.13-0.58) was noticed after adjusting for diagnosis and prematurity.
• In this study, time to reach 50% enteral nutrition reduced from a median of 10 to 6 days (P=.020) and time to reach 100% enteral nutrition reduced from 35 to 21 days (P=.035) with guideline use.
• No change in the incidence of necrotizing enterocolitis after initiating enteral nutrition was noticed (5% vs 9%, P=.346).