Presentations

Abstract

Introduction: Eating disorders in the pediatric population can require significant medical intervention for nutritional rehabilitation. Prior treatment at CHKD was gradual caloric increases beginning at 1440 kcal/day via nasogastric tube (NG). Recent literature suggests that a more rapid refeeding protocol with an average goal of 1800 kcal/day can facilitate quicker weight gain with no increased rates of refeeding syndrome or hypophosphatemia. Peebles et al. describe a protocol with excellent outcomes using primarily oral (PO) feeding and only utilizing NG tubes for food refusal or medically severe patients. We analyzed the current state of care for patients admitted for nutritional rehabilitation at CHKD and compare it to the emerging evidence to determine where we are succeeding and where there is room to improve.

Methods: Chart review of all patients admitted for nutritional rehabilitation from January 2018-March 2023, and those admitted for nutritional rehabilitation due to a primary eating disorder were included. Statistical process control charts were produced to analyze process, balancing, and outcome measures and identify special cause variation. Subgroup analysis was done evaluating the capture rate and documentation of individuals' reported sexual orientation and gender identity (SOGI) data as this population is at risk for health disparities and eating disorders.

Results: 160 patients were identified from January 2018 through December 2023. 114 met inclusion criteria. Mean goal calories at admission was 1329 kCal/day. Mean duration of NG tube use was 4.4 days and mean time to medical stabilization was 8.4 days. 88 (77%) were given phosphorous supplementation with 15 (13%) having hypophosphatemia below 3.0 mg/dL. 18 individuals (16%) had any sexual orientation documented and 29 (25%) had any gender identity documented.

Conclusion: Goal calories at initiation are lower and NG tube use is higher at this facility than current evidence recommendations, reflecting an opportunity for improvement. SOGI data needs to be captured accurately before health disparities can be analyzed. These baseline data are being used to inform an implementation project with higher initial calorie goals and initiation with PO feeding. Implementation science methodology will be used to measure and compare patient outcomes resulting from evidence-based practice changes.