Postoperative Enteral Nutrition Guidelines Reduce the Risk of Intestinal Failure–Associated Liver Disease in Surgical Infants

Darla R. Shores, Samuel M. Alaish, Susan W. Aucott, Janine E. Bullard, Courtney Haney, Heidi Tymann, Bareng A.S. Nonyane, Kathleen B. Schwarz

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Objective: To assess the effectiveness of postoperative feeding guidelines in reducing the incidence and severity of intestinal failure–associated liver disease (IFALD) among infants. Study design: Two cohorts of infants <6 months old undergoing intestinal surgery were compared: preguideline (retrospective data from 2007 to 2013; n = 83) and postguideline (prospective data from 2013 to 2016; n = 81). The guidelines included greater initial enteral nutrition volumes of 20 mL/kg/d and daily feeding advancement if tolerated. The primary outcomes were incidence of IFALD (peak direct bilirubin [DB] >2 mg/dL) and severity (DB >5 mg/dL for moderate-severe). Multiple logistic regression was used to determine the odds of developing IFALD. Other outcomes were time to reach 50% and 100% goal calories from enteral nutrition and the incidence of necrotizing enterocolitis after feeding. Results: The incidence of IFALD decreased from 71% to 51% (P =.031), and median peak DB decreased from 5.7 to 2.4 mg/dL (P =.001). After adjusting for diagnosis and prematurity, the odds of developing IFALD of any severity were reduced by 60% (OR 0.40, 95% CI 0.20-0.85), and the odds of developing moderate-to-severe IFALD were reduced by 72% (OR 0.28, 95% CI 0.13-0.58) with guideline use. Time to reach 50% enteral nutrition decreased from a median of 10 to 6 days (P =.020) and time to reach 100% enteral nutrition decreased from 35 to 21 days (P =.035) with guideline use. The incidence of necrotizing enterocolitis after initiating enteral nutrition did not change (5% vs 9%, P =.346). Conclusions: Implementation of feeding guidelines reduced time to reach feeding goals, significantly reducing IFALD incidence and severity.

Original languageEnglish (US)
Pages (from-to)140-147.e1
JournalJournal of Pediatrics
StatePublished - Apr 2018


  • atresia
  • cholestasis
  • feeding protocol
  • gastroschisis
  • necrotizing enterocolitis
  • short bowel syndrome

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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