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Improving growth of infants with congenital heart disease using a consensus-based nutritional pathway

Marino LV, et al. Clin. Nutr. 2020;39:2455-2462

Objective
Infants with congenital heart disease (CHD) often experience growth failure prior to surgery, which is associated with increased paediatric-intensive-care unit length of stay (PICU-LOS) and post-operative complications. This study assessed the impact of a pre-operative, consensus-based nutritional pathway (including support from a multi-disciplinary team) on growth and clinical outcome.

Design
Single-centre prospective pilot study.

Setting
Tertiary paediatric cardiology surgical centre.

Patients
Infants with CHD.

Intervention
Infants with CHD were followed for up to 4-months-of-age before cardiac surgery and then to 12-months-of-age following the implementation of the consensus-based nutritional-pathway (Intervention group: November 2017eAugust 2018), with outcomes compared to a historic control group. The nutrition pathway involved a dietitian contacting parents of infants with the highest risk of growth failure weekly; reviewing weight gain and providing feeding support.

Main outcome measure
Growth (weight-for-age, WAZ, and height-for-age-z-score, HAZ) at 4 and 12 months-of-age.

Results
44 infants in the intervention group were compared to 38 in the control group. Median (interquartile range) change in WAZ from birth to 4 months-of-age (0.9 (1.5, 0.7)) and from birth to 12 months-of-age (0.09 (1.3, 1.1)) in the intervention group compared to the control group (1.5 (2.0, 0.4) (p ¼ 0.04)) at 4 months-of age and at 12 months-of-age (0.4 (1.9, 0.2) (p ¼ 0.03)). HAZ at 4 months-of-age was 0.7 (1.4, 0.1) vs. 1.0 (1.9, 0.3) (p ¼ 0.6) in the intervention and control groups respectively, and at 12 months-of-age HAZ was 0.7 (1.9, 0.07) in the intervention group vs.- 1.6 (2.6, 0.4) in the control group (p ¼ 0.04). Duration of PICU-LOS was 8.2 ± 11.6 days intervention vs. 18.3 ± 24.0 days control (p ¼ 0.006).

Conclusions
Overall weight was well maintained, and growth improved in infants who followed the preoperative nutritional-pathway. The duration of PICU-LOS was significantly lower in the intervention group, which may be due to improved nutritional status, although this requires further investigation.

Click below to read a clinical paper on how this pre-operative, consensus-based nutritional pathway was developed.

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