Nutrition for Neonates with Congenital Heart Disease Clinical Pathway — CICU

Goals and Metrics

Minimize weight loss and increase overall caloric intake over the course of patient hospitalization
Optimize post-operative caloric intake, with aim to achieve ≥ 100 kcal/kg/day by POD 4 through discharge
Decrease time to:
- Initiate post-operative parenteral nutrition (PN)
- Attain goal calories
Minimize interruptions of enteral nutrition and PN
Promote positive transition to oral feeding

Total Caloric Intake Goals*: Parenteral and Enteral
Post-op Day	kcal/kg/day
1	45-50
2	50-75
3	75-100
≥ 4	≥ 100

*Goals exclude patients on parenteral nutrition ONLY.
Parenteral only goals as per dietitian recommendations.

Metrics

Increase

Percent of patient days for which patients receive ≥ 100 kcal/kg/day
Number of patients that attain ≥ 100 kcal/kg/day by post-op day 4
Improve weight-for-age z-score change over the length of stay

Decrease

Number of days to achieve ≥ 100 kcal/kg/day per patient

Balancing Measures

CLABSI rate
NEC rate
Ventilator-free days

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.