Gongwer Russell C, Gauvreau Kimberlee, Huh Susanna Y, Sztam Kevin A, Jenkins Kathy J
1Center for Applied Pediatric Quality Analytics,Boston Children's Hospital,Boston,MA,USA.
2Department of Cardiology,Boston Children's Hospital,Boston,MA,USA.
Cardiol Young. 2018 Oct;28(10):1093-1098. doi: 10.1017/S1047951118000781. Epub 2018 Sep 3.
Growth failure is prevalent among infants with CHD. A Standardized Clinical Assessment and Management Plan was introduced at Boston Children's Hospital's cardiac medical ward to identify patients with growth failure, evaluate relevant contributing conditions, and recommend a management plan including collaboration with nutrition physicians.
The objective of this study was to determine whether enrolled patients had improved growth compared with historical controls.
A total of 29 patients were enrolled in the period July, 2013-June, 2014. In all, 42 historical controls who met eligibility criteria for enrolment were selected for comparison from patients admitted to the same ward in the period June, 2010-June, 2011. Patients with CHD aged <1 year , with growth failure defined as weight-for-age z-score <-2, or failure to sustain adequate weight gain were eligible for participation. Primary outcome was change in weight-for-age z-score from enrolment to most recent weight measurement among patients with at least 6 months of follow-up.
Control patients were older at baseline admission weight (118 versus 95 days, p=0.33), and had a higher weight-for-age z-score, -2.9 (-3.1, -2.6) versus -3.7 (-4.3, -3.0) (p=0.02), compared with enrolled patients. Enrolled patients had greater gain in weight-for-age z-score, 2.7 (2.0, 3.4) versus 1.8 (1.5, 2.2) (p=0.03), from baseline to most recent follow-up.
Patients enrolled in a nutrition-focused protocol had greater weight improvement than historical controls. Identification of growth failure and collaboration with a nutrition support team was associated with improved weight gain among CHD patients experiencing growth failure. CHD programmes should consider a structural approach, including nutrition expertise to address growth failure.
生长发育迟缓在患有先天性心脏病（CHD）的婴儿中很常见。波士顿儿童医院心脏内科病房引入了标准化临床评估与管理计划，以识别生长发育迟缓的患者，评估相关影响因素，并推荐包括与营养科医生协作的管理计划。
本研究的目的是确定与历史对照相比，入组患者的生长发育是否有所改善。
2013年7月至2014年6月期间共纳入29例患者。从2010年6月至2011年6月在同一病房住院的患者中选取42例符合入组资格标准的历史对照进行比较。年龄小于1岁、生长发育迟缓定义为年龄别体重Z评分＜-2或无法维持足够体重增长的CHD患者符合参与条件。主要结局是在至少随访6个月的患者中，从入组到最近一次体重测量时年龄别体重Z评分的变化。
与入组患者相比，对照患者基线入院体重时年龄更大（118天对95天，p = 0.33），且年龄别体重Z评分更高，分别为-2.9（-3.1，-2.6）对-3.7（-4.3，-3.0）（p = 0.02）。从基线到最近一次随访，入组患者的年龄别体重Z评分增加幅度更大，分别为2.7（2.0，3.4）对1.8（1.5，2.2）（p = 0.03）。
参加以营养为重点方案的患者体重改善情况优于历史对照。识别生长发育迟缓并与营养支持团队协作与生长发育迟缓的CHD患者体重增加改善相关。CHD项目应考虑采用结构化方法，包括营养专业知识来解决生长发育迟缓问题。
