Ware Adam L, Jones Courtney, Kipps Alaina K, Khadr Lara, Marcuccio Elisa, Patel Sonali S, Plummer Sarah, Ravishankar Chitra, Figueroa Mayte
Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, 81 N. Mario Capecchi Dr, Salt Lake City, UT, 84113, USA.
Acute Care Therapy Services, Primary Children's Hospital, Salt Lake City, Utah, USA.
Pediatr Cardiol. 2025 Jun;46(5):1241-1247. doi: 10.1007/s00246-024-03541-6. Epub 2024 Jun 22.
Infants with heart disease are at high risk of feeding difficulties and complications. Feeding practices amongst acute care cardiology units are not standardized. This study aims to describe feeding practices for infants at the time of discharge from a Pediatric Acute Care Cardiology Collaborative (PAC) center and practice variation between centers. Discharge encounters for infants in the PAC registry between February 2019 and October 2021 were included. Nutrition type and feeding route at discharge were summarized with descriptive statistics and a modified bump plot. Center variation was assessed using funnel plots with control limits set at the 99.9% confidence interval from the group mean. A total of 15,414 encounters across 24 PAC centers were recorded from 8313 unique patients (median encounters 1, range 1-25). Nutrition at discharge consisted of standard formula in 8368 (54%), human milk in 6300 (41%), and elemental formula in 3230 (21%), either alone or in combination. Feeds were fortified to ≥ 24 kcal/oz in 12,359 (80%). Discharge supplemental tube feeding was present in 7353 (48%) encounters with 4643 (63%) receiving continuous feeds, 2144 (29%) bolus feeds, and 566 (8%) a combination. Funnel plots demonstrated variability in nutrition type and feeding route at discharge. Infants with heart disease commonly require high calorie nutrition and supplemental tube feedings at discharge. Feeding strategies at discharge vary widely between PAC centers. Collaborative approaches to identify best practices in feeding strategies are needed.
患有心脏病的婴儿存在喂养困难和并发症的高风险。急性护理心脏病科的喂养方法并不规范。本研究旨在描述儿科急性护理心脏病协作（PAC）中心出院时婴儿的喂养方法以及各中心之间的实践差异。纳入了2019年2月至2021年10月PAC登记处婴儿的出院记录。出院时的营养类型和喂养途径用描述性统计和改良的凸起图进行总结。使用漏斗图评估中心差异，控制限设定为组均值的99.9%置信区间。共记录了来自24个PAC中心的15414次记录，涉及8313名独特患者（中位数记录1次，范围1 - 25次）。出院时的营养包括8368例（54%）标准配方奶、6300例（41%）母乳和3230例（21%）元素配方奶，单独使用或混合使用。12359例（80%）的喂养强化至≥24千卡/盎司。7353例（48%）出院记录存在补充管饲，其中4643例（63%）接受持续喂养，2144例（29%）接受推注喂养，566例（8%）接受混合喂养。漏斗图显示出院时营养类型和喂养途径存在差异。患有心脏病的婴儿出院时通常需要高热量营养和补充管饲。PAC中心之间出院时的喂养策略差异很大。需要采用协作方法来确定喂养策略的最佳实践。
