Enteral feeding practices in infants with congenital heart disease across European PICUs : a European Society of Pediatric and Neonatal Intensive Care survey

Objectives: To describe enteral feeding practices in pre and postoperative infants with congenital heart disease in European PICUs. Design: Cross-sectional electronic survey. Setting: European PICUs that admit infants with congenital heart disease pre- and postoperatively. Participants: One senior PICU physician or designated person per unit. Interventions: None. Measurements and Main Results: Fifty-nine PICUs from 18 European countries responded to the survey. PICU physicians were involved in the nutritional care of children with congenital heart disease in most (76%) PICUs, but less than 60% of units had a dedicated dietician. Infants with congenital heart disease were routinely fed preoperatively in only 63% of the PICUs, due to ongoing concerns around prostaglandin E1 infusion, the presence of umbilical venous and/or arterial catheters, and the use of vasoactive drugs. In three quarters of the PICUs (76%), infants were routinely fed during the first 24 hours postoperatively. Units cited, the most common feeding method, both pre and postoperatively, was intermittent bolus feeds via the gastric route. Importantly, 69% of European PICUs still did not have written guidelines for feeding, but this varied for pre and postoperative patients. Conclusions: Wide variations in practices exist in the nutritional care between European PICUs, which reflects the absence of local protocols and scientific society-endorsed guidelines. This is likely to contribute to suboptimal energy delivery in this particularly vulnerable group.