Getting to the heart of the matter – Timing of feeding intervention for acute cardiac patients

1. Getting to the heart of the matter – Timing of feeding intervention for acute cardiac patients Acute Paediatric Feeding EBP group Dec 2010

2. OR……Trying to fit a square peg into a round hole? The Acute Paediatric Feeding Experience

3. 2010 – A summary • Topic dilemma – cardiac issues vs tube weaning approaches • Literature dilemma - cardiac research predominantly around nutritional outcomes vs copious (if not dubious) volume of research to support multiple tube weaning approaches • Do both??? → Cross site data collection and bench marking projects

4. Cardiac issues - EBP in reverse? • Question - Does nutritive or non-nutritive stimulation pre- cardiac surgery improve feeding outcomes in neonates? • WHY? – clinical experience indicated that early referral and intervention resulted in better long term feeding outcomes for this population however SP often not receiving timely referrals from cardiac wards/surgeons. • Clinical impression/experience – disordered feeding reflexes & oral skills, fatigue with ↑ WOB, oral aversion, tube dependency.

5. Cardiac issues - EBP in reverse? • Literature – Huge scope with predominantly nutritional and surgical outcome focus. • Gap between our clinical experience and the evidence for early intervention in the literature → square peg round hole scenario • Positive article – Predictors of Oral Feeding Difficulty in Cardiac Surgical Infants. Einarson K & Arthur H, Pediatric Nursing, July/Aug 2003, Vol. 29/No. 4

6. Cardiac issues - EBP in reverse? • “ Risk factors for feeding difficulties in the post cardiac surgery infants are VC injury, prolonged intubation and low weight at surgery. Early identification of neonates at risk for feeding difficulties may lead to development of strategies to reduce morbidity, improve patient care and improve better resource utilisation”

7. Internal Evidence – Clinical Practice • Cross site data collection • Prospective and retrospective data • Collect for 6 + months

8. Cardiac Data Collection Sheet • Patient Information • Cardiac Disorder  • Co Morbidities  • Significant Changes in Status 

9. Cardiac Data Collection Sheet • Feeding Information (provide age where possible) • Pre Surgery • Post Surgery • Outpatient • Non-nutritive sucking introduced • Suck feeds (indicate breast/ bottle or mix) • SP Intervention (pre/ post Sx) • Type of supplementary feeding (NGT, OGT, NJ, gastrostomy, jejunostomy) • Length of supplementary feeding • Changes post introduction of feeds

10. Cardiac Data Collection Sheet • Feeding Intervention (age at intervention/ current age): • Feeding Disorder  • Type of Intervention  • Service Delivery/ Frequency  • Parental Considerations/ Social situation 

11. Where to next? • Ongoing data collection • Review Feb 2011 • Back to the research and/or write our own…….. • Complete a CAT • E3BP? – include client factors and preferences • Develop clinical guidelines for neonates with cardiac disease

12. So what happened to tube weaning? • Two sites currently piloting tube weaning feeding groups based on the SOS (Sequential Oral Sensory) approach to feeding. • Other centres also looking at setting up multidisciplinary feeding groups in 2011. • Data collection and comparison of different feeding approaches across the State • Back to the research • E3BP for 2011???

13. Thank you from the members of the Acute Paediatric Feeding GroupKim AchurchDebbie AlvarezHolly DaleyValerie GentLauren GeachVictoria GilesJennifer HughesColleen LinksMelissa ParkinAnna Wheaton