Use of a learning network to improve variation in interstage weight gain after the Norwood operation

Area of Science:

• Pediatric Cardiology
• Quality Improvement Science
• Infant Nutrition

Background:

• Infants with single ventricle physiology often experience growth failure.
• The National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) network was utilized to address this challenge.
• Optimized nutritional practices were identified as a key intervention.

Purpose of the Study:

• To evaluate the effectiveness of a learning network in spreading optimized nutritional practices.
• To improve infant growth, specifically interstage weight-for-age z-score change (ΔWAZ), in single ventricle patients.
• To assess the impact of these practices on growth variation among participating sites.

Main Methods:

• A standardized Nutritional Bundle was disseminated across NPC-QIC sites.
• Interstage ΔWAZ was analyzed before and after the implementation of the Nutritional Bundle.
• Data from 407 infants undergoing stage 2 palliation (S2) between 2008 and 2013 were examined.

Main Results:

• Significant variation in interstage ΔWAZ among sites decreased after the Nutritional Bundle spread (Period 1: P = .01 vs. Period 2: P = .39).
• The proportion of patients with negative interstage ΔWAZ decreased from 43% to 32%.
• Sites with the poorest baseline growth demonstrated marked improvement in interstage ΔWAZ post-intervention.

Conclusions:

• The successful spread of optimal nutritional practices reduced interstage growth variation in single ventricle infants.
• Improvement was most pronounced at sites that initially had the worst growth outcomes.
• Collaborative quality improvement networks can effectively disseminate best practices to enhance pediatric patient growth.