Servicio de Pediatría Hospital Universitario Río Hortega, Servicio Pediatría Hospital Recoletas Campogrande, Valladolid, Spain.
Unidad de Nutrición Infantil y Enfermedades Metabólicas, Hospital Universitario La Paz, Madrid, Spain.
An Pediatr (Engl Ed). 2023 May;98(5):373-383. doi: 10.1016/j.anpede.2023.02.022. Epub 2023 May 1.
The prevalence of malnutrition among infants with congenital heart disease (CHD) is high. Early nutritional assessment and intervention contribute significantly to its treatment and improve outcomes. Our objective was to develop a consensus document for the nutritional assessment and management of infants with CHD.
We employed a modified Delphi technique. Based on the literature and clinical experience, a scientific committee prepared a list of statements that addressed the referral to paediatric nutrition units (PNUs), assessment, and nutritional management of infants with CHD. Specialists in paediatric cardiology and paediatric gastroenterology and nutrition evaluated the questionnaire in 2 rounds.
Thirty-two specialists participated. After two evaluation rounds, a consensus was reached for 150 out of 185 items (81%). Cardiac pathologies associated with a low and high nutritional risk and associated cardiac or extracardiac factors that carry a high nutritional risk were identified. The committee developed recommendations for assessment and follow-up by nutrition units and for the calculation of nutritional requirements, the type of nutrition and the route of administration. Particular attention was devoted to the need for intensive nutrition therapy in the preoperative period, the follow-up by the PNU during the postoperative period of patients who required preoperative nutritional care, and reassessment by the cardiologist in the case nutrition goals are not achieved.
These recommendations can be helpful for the early detection and referral of vulnerable patients, their evaluation and nutritional management and improving the prognosis of their CHD.
患有先天性心脏病 (CHD) 的婴儿营养不良的发生率很高。早期营养评估和干预对其治疗和改善预后有重要意义。我们的目标是制定一份关于 CHD 婴儿营养评估和管理的共识文件。
我们采用了改良 Delphi 技术。基于文献和临床经验，一个科学委员会编写了一份包含关于转诊至儿科营养单位 (PNU)、CHD 婴儿评估和营养管理的陈述清单。小儿心脏病学和小儿胃肠病学和营养学专家对问卷进行了两轮评估。
32 名专家参与了研究。经过两轮评估，185 项中的 150 项（81%）达成了共识。确定了与低和高营养风险相关的心脏病理以及与高营养风险相关的心脏或心脏外因素。委员会为营养单位的评估和随访以及营养需求、营养类型和给药途径的计算制定了建议。特别关注在术前期间需要强化营养治疗、需要术前营养护理的患者在术后期间由 PNU 随访以及在营养目标未达到时由心脏病专家重新评估的问题。
这些建议有助于早期发现和转诊脆弱患者，对他们进行评估和营养管理，并改善他们 CHD 的预后。
