Title

Standardized Feeding Approach Mitigates Weight Loss in Infants with Congenital Heart Disease.

Authors

Amy Jo Lisanti, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Melanie Savoca, Children's Hospital of Philadelphia, Philadelphia, PAFollow
J William Gaynor, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Maria R Mascarenhas, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Chitra Ravishankar, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Erin Sullivan, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Karyn Pieciak, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Andrew Costarino, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Jodi Chen, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Andrea Kennedy, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Robert Olsen, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Jungwon Min, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Antara Mondal, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Jing Huang, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Sharon Y Irving, Children's Hospital of Philadelphia, Philadelphia, PAFollow

Publication Title

The Journal of pediatrics

Document Type

Article

PubMed ID

33359473

Abstract

OBJECTIVE: To evaluate the effect of a standardized feeding approach using a clinical nutrition pathway on weight-for-age Z score (WAZ) over hospital length of stay (HLOS) for infants with congenital heart disease (CHD).

STUDY DESIGN: A 10-year retrospective cohort study examined eligible infants who underwent neonatal cardiac surgery between July 2009 and December 2018 (n = 987). Eligibility criteria included infants born at least 37 weeks of gestation and a minimum birth weight of 2 kg who underwent cardiac surgery for CHD within the first 30 days of life. Using the best linear unbiased predictions from a linear mixed effects model, WAZ change over HLOS was estimated before and after January 2013, when the standardized feeding approach was initiated. The best linear unbiased predictions model included adjustment for patient characteristics including sex, race, HLOS, and class of cardiac defect.

RESULTS: The change in WAZ over HLOS was significantly higher from 2013 to 2018 than from 2009 to 2012 (β = 0.16; SE = 0.02; P < .001), after controlling for sex, race, HLOS, and CHD category, indicating that infants experienced a decreased WAZ loss over HLOS after the standardized feeding approach was initiated. Additionally, differences were found in WAZ loss over HLOS between infants with single ventricle CHD (β = 0.26; SE = 0.04; P < .001) and 2 ventricle CHD (β = 0.04; SE = 0.02; P = .04).

CONCLUSIONS: These data suggest that an organized, focused approach for nutrition therapy using a standardized pathway improves weight change outcomes before hospital discharge for infants with single and 2 ventricle CHD who require neonatal cardiac surgery.

Keywords

Critical Pathways, Female, Heart Defects, Congenital, Hospitalization, Humans, Infant, Infant, Newborn, Linear Models, Logistic Models, Male, Nutrition Therapy, Perioperative Care, Retrospective Studies, Treatment Outcome, Weight Gain, Weight Loss

DOI

10.1016/j.jpeds.2020.12.047

Publication Date

4-1-2021

Citation

Lisanti, A., Savoca, M., Gaynor, J., Mascarenhas, M., Ravishankar, C., Sullivan, E., Pieciak, K., Costarino, A., Chen, J., Kennedy, A., Olsen, R., Min, J., Mondal, A., Huang, J., & Irving, S. (2021). Standardized Feeding Approach Mitigates Weight Loss in Infants with Congenital Heart Disease.. The Journal of pediatrics, 231, 124-130. https://doi.org/10.1016/j.jpeds.2020.12.047