How can I effectively monitor and manage the nutritional needs of an infant with biliary atresia post-surgery?

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 ¹.

Use a central venous catheter for parenteral nutrition administration unless peripheral access is necessary to avoid delays or interruptions ¹.

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 ¹.

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 ¹.

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 ¹.

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 ¹.

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 ¹.

Coordinate blood sampling to minimize volume and frequency, using agreed protocols to maximize information from each sample to reduce infant distress and blood loss ¹.

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 ¹.

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 ¹.