Enteral nutrition safety practices in pediatric transplant: Perspectives of dietitians in pediatric transplant

Background Our objective was to characterize enteral nutrition safety practices and education for pediatric solid organ transplant recipients and compare practices with the 2017 American Society for Parenteral and Enteral Nutrition (ASPEN) Safe Practices for Enteral Nutrition Therapy. Methods A 43‐question electronic survey was distributed through the national registered dietitian pediatric transplant listserv. Questions reviewed formula hang‐time, preparation, storage during initial transplant admission, and discharge education. Results Sixty‐six of 216 (31%) individuals completed at least one survey section. Forty‐one of 47 (87%) reported a standard inpatient policy, and 40/40 (100%) reported ASPEN Safe Practices compliance for nonsterile powder formula with or without additives or unfortified and fortified human milk, whereas 33/39 (85%) complied for sterile liquid formula in an open system. Hospital size, type, and location did not predict compliance practices. Discharge education was primarily provided by dietitians (98%) and nurses (37%). Four‐hour hang‐time education was provided by 18/42 (43%) respondents for sterile formula in an open system, 31/42 (74%) for nonsterile powder formula in an open system, and 35/42 (83%) for nonsterile formula with additives. Educator type (dietitian vs non‐dietitian or nurse vs non‐nurse) did not predict compliance for sterile liquid in open system or nonsterile powder formula in an open system. Conclusion Inpatient policies for formula hang‐time are highly compliant with 2017 ASPEN recommendations. However, formula hang‐time discharge education varied, particularly for sterile liquid formula in an open system. Standardizing enteral nutrition safety education for transplant patients is critical for minimizing infection risk within this immunocompromised population.