School of Nursing, University of Minnesota, Minneapolis, MN, USA.
School of Nursing, University of Wisconsin, Madison, WI, USA.
Cardiol Young. 2021 Apr;31(4):577-588. doi: 10.1017/S1047951120004370. Epub 2020 Dec 11.
To determine clinical consensus and non-consensus in regard to evidence-based statements about feeding infants with complex CHD, with a focus on human milk. Areas of non-consensus may indicate discrepancies between research findings and practice, with consequent variation in feeding management.
A modified Delphi survey validated key feeding topics (round 1), and determined consensus on evidence-based statements (rounds 2 and 3). Patients (n=25) were an interdisciplinary group of clinical experts from across the United States of America. Descriptive analysis used SPSS Statistics (Version 26.0). Thematic analysis of qualitative data provided context for quantitative data.
Round 1 generated 5 key topics (human milk, developing oral feeding skills, clinical feeding practice, growth failure, and parental concern about feeding) and 206 evidence-based statements. The final results included 110 (53.4%) statements of consensus and 96 (46.6%) statements of non-consensus. The 10 statements of greatest consensus strongly supported human milk as the preferred nutrition for infants with complex CHD. Areas of non-consensus included the adequacy of human milk to support growth, need for fortification, safety, and feasibility of direct breastfeeding, issues related to tube feeding, and prevention and treatment of growth failure.
The results demonstrate clinical consensus about the importance of human milk, but reveal a need for best practices in managing a human milk diet for infants with complex CHD. Areas of non-consensus may lead to clinical practice variation. A sensitive approach to these topics is needed to support family caregivers in navigating feeding concerns.
确定有关喂养患有复杂 CHD 的婴儿的循证声明的临床共识和非共识，重点关注人乳。非共识领域可能表明研究结果与实践之间存在差异，继而导致喂养管理的变化。
一项经修改的 Delphi 调查验证了关键喂养主题（第 1 轮），并确定了对循证声明的共识（第 2 轮和第 3 轮）。患者（n=25）是来自美国各地的跨学科临床专家团队。使用 SPSS Statistics（版本 26.0）进行描述性分析。对定性数据的主题分析为定量数据提供了背景。
第 1 轮产生了 5 个关键主题（人乳、发展口腔喂养技能、临床喂养实践、生长不良和父母对喂养的担忧）和 206 条循证声明。最终结果包括 110 条（53.4%）共识声明和 96 条（46.6%）非共识声明。10 条最具共识的声明强烈支持将人乳作为患有复杂 CHD 的婴儿的首选营养。非共识领域包括人乳支持生长的充足性、强化的必要性、安全性和直接母乳喂养的可行性、与管饲相关的问题以及生长不良的预防和治疗。
结果表明，临床医生对人乳重要性的共识，但也揭示了需要制定最佳实践来管理患有复杂 CHD 的婴儿的人乳饮食。非共识领域可能导致临床实践的差异。需要采取敏感的方法来处理这些问题，以支持家庭照顾者解决喂养问题。
