P2.011: Just feed the baby: process simplification and data transparency improve pre-operative oral feeding in neonates

Purpose/Objectives: Pre-operative oral feeding in neonates with congenital heart disease (CHD) is associated with oral feeding at discharge and freedom from gastrostomy. We aim to increase the rate of oral feeding in pre-op neonates from a baseline of 47% to 70%, via process simplification and data transparency in order to immediately begin feeding after delivery.

Design/Methods: This is a prospective QI, single center study. Baseline pre-implementation data was collected from the electronic medical record. We reviewed patients who had cardiac surgery aged ≤ 30 days from January 2022 to March 2025. Inclusion criteria were ≥ 2 pre-operative days after admission and born at ≥ 35 weeks gestation. There were no additional exclusion criteria. For both pre-/post-implementation, we collected daily oral feeding volume, birthweight, features of the CHD, and incidence of pre-operative necrotizing entero-colitis (NEC). We defined pre-operative oral feeding as ≥10 mL/kg in a 24-hour period.

We surveyed Heart Center physicians and providers (NICU, CICU, cardiology) to determine barriers and comfort level with orally feeding pre-operative neonates. Prior to the 4th quarter of 2023, we implemented the following: 24-hour access to milk bank for cardiac NICU staff, sharing survey results, and monthly data sharing on project progress demonstrated in a p-chart.

Results: In our survey (39 respondents of possible 50), there was excellent agreement between all providers that it was important to encourage oral feeding pre-operatively and that donor breastmilk was appropriate. There was good agreement that PO feeding was not a significant risk factor for NEC, and majority of providers were comfortable with orally feeding across all lesions (Table 1).

Baseline data included 87 patients, of which 41 (47%) were orally fed >10 mL/kg. The median for maximum oral intake was 39 mL/kg [quartile range 18, 90]. Single ventricle patients were fed 36%, transposition 32%, coarctation 74%, biventricular-PGE for pulmonary blood flow 60%. After implementation the rate of oral feeding increased to 73% (55/75) (Figure 1), while maintaining a pre-operative NEC rate of 0%. Additionally, the median maximum oral intake increased significantly to 67 mL/kg [27,112] (p = 0.01). Intake of at least 20 mL/kg increased from 29% to 59% (p = 0.01)

Conclusion/Discussion: Our interventions focused on simplification of the process required to orally feed neonates with transparent and frequent data sharing. This resulted in a significant and sustained increase in the rate of pre-operative oral feeding without an increase in the rate of NEC. We also intend to evaluate this program’s effect on rate of need for tube feeding at discharge.