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

Luise V Marino1, Mark J Johnson2, Natalie J Davies3

  • 1Department of Dietetics/ SLT, University Hospital Southampton NHS Foundation Trust, SO16 6YD, UK; NIHR Biomedical Research Centre Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, S016 6YD, UK; School of Health Sciences, University of Southampton, UK.

Clinical Nutrition (Edinburgh, Scotland)
|November 18, 2019
PubMed

Insights

A pre-operative nutritional pathway improved growth in infants with congenital heart disease (CHD). This intervention also significantly reduced paediatric-intensive care unit length of stay (PICU-LOS), suggesting better clinical outcomes.

Area of Science:

  • Pediatric Cardiology
  • Nutritional Science
  • Critical Care Medicine

Background:

  • Infants with congenital heart disease (CHD) frequently experience growth failure before surgery.
  • Pre-operative growth failure in CHD is linked to longer paediatric-intensive care unit stays (PICU-LOS) and increased post-operative complications.
  • Optimizing nutritional status pre-operatively is crucial for improving outcomes in these vulnerable infants.

Purpose of the Study:

  • To evaluate the impact of a consensus-based, pre-operative nutritional pathway on growth in infants with CHD.
  • To assess the effect of this nutritional intervention on clinical outcomes, including PICU-LOS.
  • To determine if multidisciplinary team support within the nutritional pathway enhances patient management.

Main Methods:

  • A single-centre prospective pilot study compared an intervention group (n=44) with a historic control group (n=38).
  • The intervention involved a pre-operative nutritional pathway with weekly dietitian contact for high-risk infants, focusing on weight gain and feeding support.
  • Growth (weight-for-age z-score [WAZ] and height-for-age z-score [HAZ]) and PICU-LOS were measured at 4 and 12 months of age.

Main Results:

  • The intervention group showed improved weight-for-age z-score (WAZ) at 12 months compared to controls (p=0.03).
  • Height-for-age z-score (HAZ) was significantly better in the intervention group at 12 months (p=0.04).
  • Paediatric-intensive care unit length of stay (PICU-LOS) was significantly reduced in the intervention group (8.2 days vs. 18.3 days, p=0.006).

Conclusions:

  • A pre-operative nutritional pathway effectively maintained overall weight and improved growth in infants with CHD.
  • The intervention led to a significant reduction in PICU-LOS, potentially due to improved nutritional status.
  • This pathway, supported by a multidisciplinary team, demonstrates promise for enhancing clinical outcomes in pediatric cardiac surgery patients.
Abstract

Keywords:
Congenital heart diseaseGrowthHome-monitoringInfantsNutrition

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