Improving Outcomes for Infants with Single Ventricle Physiology through Standardized Feeding during the Interstage

Abstract

Congenital heart disease is identified as the most common birth defect with single ventricle physiology carrying the highest mortality. Staged surgical palliation is required for treatment, with mortality historically as high as 22% in the four- to six-month period from the first- to second-stage surgical palliation, known as the interstage. A standardized postoperative feeding approach was implemented through an evidence-based protocol, parent engagement, and interprofessional team rounds. Five infants with single ventricle physiology preprotocol were compared with five infants who received the standardized feeding approach. Mann-Whitney U tests were conducted to evaluate the hypotheses that infants in the intervention condition would consume more calories and have a positive change in weight-to-age z-score (WAZ) and shorter length of stay (LOS) following the first and second surgeries compared to infants in the control condition. After the protocol, the change in WAZ during the interstage increased by virtually one standard deviation from 0.05 to 0.91. Median LOS dropped 32% after the first surgery and 43% after the second surgery. Since first- and second-stage palliative surgeries occur within the same year of life, this represents savings of $500,000 to $800,000 per year in a 10-infant model. The standardized feeding approach improved growth in single ventricle infants while concurrently lowering hospital costs.

Maternal factors and preoperative nutrition in children with mild cases of congenital heart disease

“…Increased rates of mortality and postsurgical infection also have been reported for children with a poor nutrition status (Anderson, Kalkwarf, Kehl, Eghtesady, & Marino, ). In addition, several interventions were conducted to improve the nutritional delivery and nutrition status in critically ill children with heart disease (Kaufman et al , ; Weston et al , ). Being different from infants with complex CHD (SV and CR), for preschoolers with SR CHD, 2–4 years of age has been identified as the best term for surgical repair (Wasserman, Zhu, & Schlichter, ).…”

The REACH protocol: an innovative strategy for home management of infants with complex CHD

“…Recommendations for increasing caloric intake were provided using established protocols. 18 In the event of clinical concerns during the virtual home visits, recommendations were made as previously discussed. Finally, medication changes, and any visits to the paediatrician, cardiologist, or emergency department visits were reviewed.…”

“…, 17 Patients are discharged with infant weighing scales and pulse oximeters to monitor daily weight, enteral intake, and systemic oxygen saturation. In most programmes, parents review these data weekly with a nurse practitioner and discuss feeding strategies using standardised nutritional guidelines to optimise weight gain during the interstage period 18 . In conventional home monitoring programmes, parents report varying abilities to communicate with providers about these protocol violations such as changes in infant behaviour or appearance or a parental feeling that “something is not right” 12 …”

“…In most programmes, parents review these data weekly with a nurse practitioner and discuss feeding strategies using standardised nutritional guidelines to optimise weight gain during the interstage period. 18 In conventional home monitoring programmes, parents report varying abilities to communicate with providers about these protocol violations such as changes in infant behaviour or appearance or a parental feeling that "something is not right". 12 The implementation of conventional home monitoring programmes has generally been associated with decreased mortality but inconsistent effects on infant weight gain and parental anxiety.…”

Preditores clínicos do risco de broncoaspiração em crianças com cardiopatias congênitas

“…Podem afetar o interior das paredes do coração, as válvulas cardíacas, veias e artérias (Institute N-NHL and B, 2011;Pereira et al, 2015). A incidência estimada de CC é de seis a dez a cada 1000 nascidos vivos, afetando mais de um milhão de crianças no mundo anualmente (Lopes, 2011;Weston et al, 2016;Mcgrattan et al, 2017). (Tikkanen et al, 2018).…”