NeoCHIRP: A Collaborative Care Model for Intestinal Rehabilitation in the NICU
Friday, February 14, 2020
2:15 PM – 2:30 PM
Location: Max Bell - MB251
Introduction: Many children with intestinal failure (IF) start their course in the NICU with medical or surgical conditions limiting enteral feeding. Multidisciplinary intestinal rehabilitation teams have improved outcomes in pediatric IF patients, but this is not well documented in neonates. We describe a collaborative multidisciplinary team, NeoCHIRP, the neonatal arm of the Children’s Intestinal Rehabilitation (IR) Program.
Methods: Retrospective descriptive chart review of neonates at risk for IF admitted between April 1, 2013 and March 31, 2019 to one tertiary care NICU. These neonates were evaluated weekly by the NeoCHIRP team, composed of surgeons, dieticians, neonatologists, an IR paediatrician, nurses and patient families, to evaluate nutritional status, and provide recommendations. Data collected included patient characteristics, intestinal pathology, anthropometrics, number of NeoCHIRP visits, nutritional support, recommendations, cholestasis interventions, successful oral tolerance, and survival.
Results: Of the 163 patients seen, there were 105 males and 58 females, gestational ages between 23-43 4/7 weeks (median= 35), who received 1-27 weekly visits (mean= 9.1). There were 153 survivors discharged from the NICU and 10 deaths (3 from IF related complications.) Enteral autonomy was achieved by 85.3% patients. The most common recommendations were: enteral feeds (96.3%), parenteral nutrition (95%), and sodium management (93.9%). Oral stimulation was recommended in 79.1%, with 40.5% exclusively and 20.2% partially orally fed by discharge. Cholestasis interventions were proposed in 66.9%, resulting in conjugated bilirubin 30 umol/L at discharge in 23/163 patients. Patient weights showed increased z-scores in 23/153 (15%) from birth to discharge whereas there were increased z-scores in 51/141 (36.2%) from NeoCHIRP consult to discharge.
Conclusion: A Multidisciplinary Neonatal IR Team is a collaborative model to support NICU medical management, by focusing on the nutritional management, resulting in improved weight gain, while minimizing cholestasis and oral aversion.