Effective monitoring and management of the nutritional needs of an infant with biliary atresia following surgery involves a multidisciplinary approach tailored to the infant's individual needs. Start parenteral nutrition as soon as possible if enteral feeding is insufficient or interrupted, ideally within 8 hours of indication, to ensure adequate nutritional support during recovery NICE NG154.
Use a central venous catheter for parenteral nutrition administration unless peripheral access is necessary to avoid delays or interruptions NICE NG154.
Monitor blood glucose levels 1 to 2 hours after starting parenteral nutrition and after each change of the nutrition bag, increasing frequency if there are concerns such as previous hypo- or hyperglycaemia or clinical instability NICE NG154.
Regularly measure blood pH, potassium, chloride, and calcium daily during initiation and dose increases, then twice weekly at maintenance, with more frequent checks if abnormalities or clinical concerns arise NICE NG154.
Serum triglycerides should be measured daily while increasing lipid dosage and weekly at maintenance, with more frequent monitoring if elevated or if the infant is critically ill NICE NG154.
Serum or plasma phosphate levels require daily monitoring during dose escalation and weekly thereafter, with increased frequency if levels are abnormal or if there is risk of metabolic bone disease NICE NG154.
Liver function tests should be performed weekly to monitor for cholestasis or liver dysfunction, with more frequent testing if abnormalities are detected or clinical concerns exist NICE NG154.
Coordinate blood sampling to minimize volume and frequency, using agreed protocols to maximize information from each sample to reduce infant distress and blood loss NICE NG154.
Provide tailored information and support to parents and carers about the importance of nutrition, the process of parenteral nutrition, monitoring plans, and how progress will be assessed and managed NICE NG154.
Engage a specialist multidisciplinary team including neonatologists, paediatric gastroenterologists, dietitians, pharmacists, and nurses to oversee nutritional management and adjust plans based on the infant’s clinical status and growth NICE NG154.