Optimizing Nutrition in Pediatric Burn Patients: A Quality Improvement Initiative.

INTRODUCTION: Pediatric burn patients require up to twice their basal nutritional needs for healing and growth. Perioperative fasting is a modifiable source of nutritional interruption. Recent investigations show that liberalized feeding protocols do not increase aspiration risk. This study aimed to identify and mitigate nutritional barriers in operative pediatric burn patients. METHODS: A multidisciplinary team identified key drivers of prolonged fasting. A standardized protocol was implemented using concentrated feeding formulas, continuing enteral feeds through procedures in intubated patients, and allowing high-protein clear liquids for up to two hours preoperatively in nonintubated patients. Primary outcomes included preoperative fasting duration and caloric and protein intake. Secondary outcomes included length of stay and perioperative complications. RESULTS: Thirty patients were included (15 baseline and 15 intervention). Statistical process control analysis showed sustained reduction in preoperative fasting duration following protocol implementation. Among patients receiving tube feeding, median nil per os duration decreased from 11-hour baseline to 5.6 hours (P < 0.001), whereas caloric and protein intake increased (both P < 0.001). When adjusted for surgical start time and feeding modality, intervention status was associated with shorter fasting duration and increased caloric and protein delivery. No aspiration events occurred. CONCLUSIONS: Perioperative fasting is a contributor to nutritional outcomes in pediatric burn patients. A quality improvement initiative reduced fasting durations and improved perioperative caloric and protein delivery without increasing aspiration risk, impacting length of stay, or increasing perioperative complications. This approach is feasible in centers with varying resources and may be adapted to other pediatric surgical populations.