A cross-sectional audit of the prevalence of stunting in children attending a regional paediatric cardiology service

Marino, Luise V.; Magee, Alan G.

doi:10.1017/s1047951115001778

Cited by 26 publications

(36 citation statements)

References 11 publications

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“…Malnutrition is associated with prolonged PICU-LOS, increased morbidity and mortality (29,31,(52)(53)(54) , with a reported incidence of up to 24% in European centres (55)(56)(57) . In the present study, the incidence of moderate acute and persistent malnutrition was similar in both units with 16%-18%.…”

Section: Discussionmentioning

confidence: 99%

Peptide nutrient‐energy dense enteral feeding in critically ill infants: an observational study

Marino

Eveleens

Morton

et al. 2019

J Human Nutrition Diet

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Background Enteral feeding is challenging in critically ill infants. Target intakes are often not achieved as a result of fluid restriction, procedural interruptions and perceived enteral feeding intolerance. In those infants perceived to have poor feeding tolerance, the use of a peptide nutrient‐energy dense enteral feed (PEF) may improve nutritional intake and minimise feeding interruptions as a result of gastrointestinal symptoms. The aim of this observational study was to characterise the use of a PEF amongst critically ill infants in two paediatric intensive care units (PICUs). Methods Records from critically ill infants aged <12 months admitted to two PICUs were retrospectively reviewed with a PICU length of stay (LOS) ≥ 7 days. Achievement of nutritional targets for the duration of PEF was reviewed. Gastrointestinal symptoms, including gastric residual volume, constipation and vomiting, were evaluated as tolerance parameters. Results In total, 53 infants were included, with a median age on admission of 2.6 months. Median admission weight was 3.9 kg in PICU‐1 and 4.7 kg in PICU‐2. Median (interquatile range) energy intake in PICU‐1 and PICU‐2 was 68 (47–92) and 90 (63–124) kcal kg−1, respectively, and median (interquatile range) protein intake 1.7 (1.1–2.4) g kg−1 and 2.5 (1.6–3.2) g kg−1, respectively. Feeding was withheld because of feeding intolerance in one infant (4%) on two occasions in PICU‐1 for 2.5 h and in two infants (7%) on two occasions in PICU‐2 for 19.5 h. Gastric residual mean (SD) volumes were 3.5 (5.4) mL kg−1 in PICU‐1 and 16.9 (15.6) mL kg−1 in PICU‐2. Conclusions Peptide nutrient‐energy dense feeding in infants admitted to the PICU is feasible, well tolerated and nutritional targets are met. However, with this study design, it is not possible to draw any conclusions regarding the benefit of PEF over standard PE feed in critically ill children and future work is required to clarify this further.

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Section: Discussionmentioning

confidence: 99%

Peptide nutrient‐energy dense enteral feeding in critically ill infants: an observational study

Marino

Eveleens

Morton

et al. 2019

J Human Nutrition Diet

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“…In particular, growth failure during the first 2 years of life is considered to be a significant concern in infants with CHD. 3 Growth failure is multifactorial, arising from feeding intolerance owing to gastrointestinal dysmotility, delayed gastric emptying, and a low intake of a range of macronutrients and micronutrients such as phosphate, zinc, sodium, magnesium, and potassium, 8,14 arising from feeding difficulties that are often associated with feeding intolerance. 15 The use of anti-reflux medication to manage reflux and associated feeding intolerance is associated with decreased intestinal absorption of phosphate.…”

Section: Discussionmentioning

confidence: 99%

“…1 Infants with CHD often have persistent malnutrition during the first few years of life, 2 which has an impact on clinical outcomes post surgery, length of hospital stay, and long-term health. 3 Gastrointestinal manifestations and feed intolerance are common features among infants with CHD, with symptoms including vomiting, diarrhoea, bloating, constipation, and gastrooesophageal reflux. 4 Many of these, often severe but nonspecific gastrointestinal symptoms, are associated with cow's milk protein allergy/intolerance and as a result infants are often prescribed an amino acid infant formula with the aim of improving feeding tolerance and symptom resolution, without a definitive diagnosis of cow's milk protein allergy.…”

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confidence: 99%

Hypophosphataemia in infants with CHD treated with amino acid infant formula

Marino

Venkatesh

et al. 2018

Cardiol Young

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After the introduction of an amino acid formula, weight gain was significantly lower among those infants with low phosphate levels. There was a significantly higher prevalence of hypophosphataemia among infants with CHD after the introduction of amino acid infant formula. Lower phosphate levels were associated with lower weight-for-age z scores. Infants with CHD are susceptible to poor weight gain; it is therefore, crucial the nutritional status of infants prescribed amino acid infant formula is more closely monitored to ensure adequate growth.

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“…Infants with CHD are particularly vulnerable to the risk of malnutrition. 33,34 The results from the survey would suggest a preference for the use of maternal breast milk, potentially without any modification particularly as breast milk contains 8 to 10% of medium chain triglycerides. 35 The implication for practice suggests that there may be a need to investigate the minimum amount of long chain triglycerides restriction required for symptom resolution in order to better promote and protect breastfeeding, particularly as this patient population is vulnerable to pre-morbid malnutrition and growth restriction 34,36 with poor weight gain post surgery associated with increased risk of mortality.…”

Section: Best-practice Guidelines With a Multidisciplinary Teammentioning

confidence: 99%

An international survey of the nutrition management of chylothorax: a time for change

Marino¹,

Bell

Woodgate

et al. 2019

Cardiol Young

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Introduction:Although chylothorax is an uncommon complication following paediatric cardiothoracic surgery, it has significant associated morbidities and increased in-hospital mortality, as well as results in higher costs. A lack of prospective evidence or consensus guidelines for management of chylothorax further hinders optimal management. The aim of this survey was to characterise variations in practice in the management of chylothorax and to identify areas for future research.Materials and methods:A descriptive, observational survey investigating conservative management practices of chylothorax was distributed internationally to health-care professionals in paediatric intensive care and cardiology units. The survey investigated five domains: the first providing general information about health-care professionals and four domains focusing on clinical practice including diet composition and duration.Results:In total, sixty-four health-care professionals completed the survey, representing 38 organisations from 16 countries. The respondents were dietitians (80%), physicians (19%), and nurses (1%). In Australia and New Zealand, management was most commonly directed by physicians’ preference (67%) as compared to unit protocols in Europe (67%), United States of America (67%), and Other regions (55%). Dietitians in Australia/New Zealand, United Kingdom, and Ireland followed the most restrictive diet therapy recommending <5 g long chain triglyceride fat per day (p < 0.00001). The duration of diet therapy significantly varied between regions: Australia/New Zealand: 4 weeks (36%) and 6 weeks (43%); Europe: 4 weeks (25%) and 6 weeks (57%); and North America: 4 weeks (18%) and 6 weeks (75%) (p < 0.00001).Conclusions:This survey highlights international variations in practice in the management of chylothorax, particularly with respect to treatment duration and dietary fat restriction. Future research should include a multi-centre randomised controlled trial to inform evidence-based practice and reduce morbidity, particularly poor growth.

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A cross-sectional audit of the prevalence of stunting in children attending a regional paediatric cardiology service

Cited by 26 publications

References 11 publications

Peptide nutrient‐energy dense enteral feeding in critically ill infants: an observational study

Peptide nutrient‐energy dense enteral feeding in critically ill infants: an observational study

Hypophosphataemia in infants with CHD treated with amino acid infant formula

An international survey of the nutrition management of chylothorax: a time for change

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