Amy Jo Lisanti1, Melanie Savoca2, J William Gaynor3, Maria R Mascarenhas4, Chitra Ravishankar5, Erin Sullivan2, Karyn Pieciak2, Andrew Costarino6, Jodi Chen6, Andrea Kennedy7, Robert Olsen7, Jungwon Min8, Antara Mondal8, Jing Huang9, Sharon Y Irving1. 1. Children's Hospital of Philadelphia, Nursing and Clinical Care Services, Philadelphia, PA; University of Pennsylvania, School of Nursing, Philadelphia, PA. 2. Children's Hospital of Philadelphia, Nursing and Clinical Care Services, Philadelphia, PA. 3. Children's Hospital of Philadelphia, Division of Pediatric Cardiothoracic Surgery, Philadelphia, PA; University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA. 4. University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA; Children's Hospital of Philadelphia, Division of Gastroenterology, Hepatology and Nutrition, Philadelphia, PA. 5. University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA; Children's Hospital of Philadelphia, Division of Cardiology, Philadelphia, PA. 6. University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA; Children's Hospital of Philadelphia, Division of Cardiac Critical Care Medicine, Philadelphia, PA. 7. Children's Hospital of Philadelphia, Center for Healthcare and Quality Analytics, Philadelphia, PA. 8. Children's Hospital of Philadelphia, Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Philadelphia, PA. 9. Children's Hospital of Philadelphia, Research Institute, Philadelphia, PA; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
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.
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.
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