The development of a consensus-based nutritional pathway for infants with CHD before surgery using a modified Delphi process

Abstract

IntroductionDespite improvements in the medical and surgical management of infants with CHD, growth failure before surgery in many infants continues to be a significant concern. A nutritional pathway was developed, the aim of which was to provide a structured approach to nutritional care for infants with CHD awaiting surgery.Materials and methodsThe modified Delphi process was development of a nutritional pathway; initial stakeholder meeting to finalise draft guidelines and develop questions; round 1 anonymous online survey; round 2 online survey; regional cardiac conference and pathway revision; and final expert meeting and pathway finalisation.ResultsPaediatric Dietitians from all 11 of the paediatric cardiology surgical centres in the United Kingdom contributed to the guideline development. In all, 33% of participants had 9 or more years of experience working with infants with CHD. By the end of rounds 1 and 2, 76 and 96% of participants, respectively, were in agreement with the statements. Three statements where consensus was not achieved by the end of round 2 were discussed and agreed at the final expert group meeting.ConclusionsNutrition guidelines were developed for infants with CHD awaiting surgery, using a modified Delphi process, incorporating the best available evidence and expert opinion with regard to nutritional support in this group.

Development of feeding information for infants with CHD

“…Lower child health-related quality of life was associated with children who had single ventricles, other physical comorbidity, feeding difficulties, and greater levels of maternal psychological stress; in contrast, maternal health-related quality of life was strongly associated with poorer family functioning, greater maternal psychological stress, difficult child temperament, and child physical comorbidity. 43 Future work is required to better understand whether there are potentially modifiable factors of parental health-related quality of life through the use of feeding-related parent information, improving growth through the use of nutrition care pathway 14 and the support from a dietician/Health Care Professionals (HCP) before and following surgery, particularly for infants who have feeding difficulties, for example, transition to textured complementary food and oral feeding.…”

“…[20][21][22][23][24][25] In addition, we incorporated information from the consensus nutritional pathway for infants with CHD before surgery, previously developed by our research group. 14…”

Enteral Nutrition in Term Infants with Congenital Heart Disease: Knowledge Gaps and Future Directions to Improve Clinical Practice

“…Specific feeding protocols have been developed by several institutions caring for CHD patients [ 10 , 19 , 23 , 27 , 29 , 30 ].…”

Nutritional support with energy and nutrient-dense formula for children with congenital heart defects: A clinical trial

“…Although the cause of growth failure is multifactorial in these infants, it is fundamentally related to increased energy expenditure and inadequate caloric intake for growth (6)(7)(8). Because of this hyper metabolic state (9), their need for energy may be 20 to-50% higher compared to that of healthy children, to obtain normal growth and development (3,(10)(11)(12). Furthermore, associated chromosomal or other abnormalities and syndromes may also have an impact on feeding/nutrition (3,6).…”

“…The severity of growth failure in these infants is most commonly determined using the weight for age Z-score, length for age Z-score and head circumference (16,17). Failure to thrive is an important factor in the decisionmaking algorithm for the treatment of patients with CHD (11,18). Persistent malnutrition at the time of surgery has been reported to affect the outcome of cardiac surgery and to increase ICU and hospital stay and morbidity (6,(19)(20)(21)(22).…”