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Feeding Variation Among Infants in Acute Care Cardiology Units
Adam L Ware1, Courtney Jones2, Alaina K Kipps3
1Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, 81 N. Mario Capecchi Dr, Salt Lake City, UT, 84113, USA. adam.ware@hsc.utah.edu.
Insights
Infants with heart disease often need specialized nutrition and tube feeding at discharge. Feeding practices vary significantly across pediatric acute care cardiology centers, highlighting a need for standardized approaches.
Area of Science:
- Pediatric Cardiology
- Neonatal Nutrition
- Clinical Practice Variation
Background:
- Infants with congenital heart disease (CHD) face significant risks of feeding difficulties and related complications.
- Current feeding practices in acute care cardiology units lack standardization, leading to inconsistent care.
- Understanding discharge feeding strategies is crucial for optimizing outcomes in this vulnerable population.
Purpose of the Study:
- To describe the feeding practices for infants at the time of discharge from Pediatric Acute Care Cardiology Collaborative (PAC3) centers.
- To assess and quantify practice variation in discharge feeding strategies among participating PAC3 centers.
Main Methods:
- Analysis of discharge encounters from the PAC3 registry (February 2019 - October 2021).
- Descriptive statistics and modified bump plots used to summarize nutrition type and feeding routes.
- Funnel plots employed to evaluate center-specific variation in feeding practices.
Main Results:
- Over 15,000 encounters across 24 centers revealed diverse discharge nutrition: 54% standard formula, 41% human milk, 21% elemental formula.
- 80% of feeds were fortified to ≥24 kcal/oz.
- Supplemental tube feeding was utilized in 48% of encounters, with variations in continuous vs. bolus methods.
Conclusions:
- Infants with heart disease frequently require high-calorie nutrition and supplemental tube feeding upon discharge.
- Significant variability exists in discharge feeding strategies across PAC3 centers.
- Collaborative efforts are essential to establish evidence-based best practices for infant feeding in pediatric cardiology.
Abstract:
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 (PAC3) center and practice variation between centers. Discharge encounters for infants in the PAC3 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 PAC3 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 PAC3 centers. Collaborative approaches to identify best practices in feeding strategies are needed.
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