Improving growth of infants with congenital heart disease using a consensus-based nutritional pathway

Abstract

Objective: Infants with congenital heart disease (CHD) often experience growth failure prior to surgery, which is associated with increased paediatric-intensive-care unit length of stay (PICU-LOS) and post-operative complications. This study assessed the impact of a pre-operative, consensus-based nutritional pathway (including support from a multi-disciplinary team) on growth and clinical outcome. Design: Single-centre prospective pilot study. Setting: Tertiary paediatric cardiology surgical centre. Patients: Infants with CHD. Intervention: Infants with CHD were followed for up to 4-months-of-age before cardiac surgery and then to 12-months-of-age following the implementation of the consensus-based nutritional-pathway (Intervention group: November 2017–August 2018), with outcomes compared to a historic control group. The nutrition pathway involved a dietitian contacting parents of infants with the highest risk of growth failure weekly; reviewing weight gain and providing feeding support. Main outcome measure: Growth (weight-for-age, WAZ, and height-for-age-z-score, HAZ) at 4 and 12 months-of-age. Results: 44 infants in the intervention group were compared to 38 in the control group. Median (inter quartile range) change in WAZ from birth to 4 months-of-age (−0.9 (−1.5, 0.7)) and from birth to 12 months-of-age (−0.09 (−1.3, 1.1)) in the intervention group compared to the control group (−1.5 (−2.0, −0.4) (p = 0.04)) at 4 months-of age and at 12 months-of-age (−0.4 (1.9, 0.2) (p = 0.03)). HAZ at 4 months-of-age was −0.7 (−1.4, −0.1) vs. −1.0 (−1.9, −0.3) (p = 0.6) in the intervention and control groups respectively, and at 12 months-of-age HAZ was −0.7 (−1.9, −0.07) in the intervention group vs.-1.6 (−2.6, −0.4) in the control group (p = 0.04). Duration of PICU-LOS was 8.2 ± 11.6 days intervention vs. 18.3 ± 24.0 days control (p = 0.006). Conclusion: Overall weight was well maintained and growth improved in infants who followed the pre-operative nutritional-pathway. The duration of PICU-LOS was significantly lower in the intervention group, which may be due to improved nutritional status, although this requires further investigation.