Children's Hospital of Philadelphia, Nursing and Clinical Care Services, Philadelphia, PA; University of Pennsylvania, School of Nursing, Philadelphia, PA.
Children's Hospital of Philadelphia, Nursing and Clinical Care Services, Philadelphia, PA.
J Pediatr. 2021 Apr;231:124-130.e1. doi: 10.1016/j.jpeds.2020.12.047. Epub 2020 Dec 23.
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).
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.
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).
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.
评估使用临床营养路径的标准化喂养方法对先天性心脏病（CHD）婴儿住院期间体重与年龄 Z 评分（WAZ）的影响。
这是一项回顾性队列研究，对 2009 年 7 月至 2018 年 12 月期间接受新生儿心脏手术的 987 例符合条件的婴儿进行了检查。纳入标准包括胎龄至少 37 周且出生体重至少 2kg 的婴儿，他们在生命的前 30 天内因 CHD 接受了心脏手术。使用线性混合效应模型的最佳线性无偏预测，估计了 2013 年 1 月（标准化喂养方法开始时）前后 HLOS 期间 WAZ 的变化。最佳线性无偏预测模型包括对患者特征的调整，包括性别、种族、HLOS 和心脏缺陷类型。
在控制了性别、种族、HLOS 和 CHD 类别后，2013 年至 2018 年与 2009 年至 2012 年相比，WAZ 随 HLOS 的变化明显更高（β=0.16；SE=0.02；P<.001），表明在标准化喂养方法开始后，婴儿在 HLOS 期间经历了 WAZ 损失减少。此外，在单心室 CHD（β=0.26；SE=0.04；P<.001）和双心室 CHD（β=0.04；SE=0.02；P=.04）婴儿中，WAZ 随 HLOS 的损失存在差异。
这些数据表明，使用标准化通路的营养治疗有组织、有重点的方法可改善需要新生儿心脏手术的单心室和双心室 CHD 婴儿在出院前的体重变化结果。
