Association between consensus-based nutrition pathway and growth faltering in infants with gastroschisis: A retrospective cohort study

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Journal of Parenteral and Enteral Nutrition Pub Date : 2024-10-06 DOI:10.1002/jpen.2692

Katie M. Strobel MD, MSCR, Katelin Kramer MD, Catherine Rottkamp MD, PhD, Cherry Uy MD, Erika Fernandez MD, Laurel Moyer MD, David Elashoff PhD, Animesh Sabnis MD, MSHS, Daniel A. DeUgarte MD, MSCR, Kara L. Calkins MD, MSCR

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引用次数: 0

Abstract

Background

The University of California Fetal Consortium published that 55% of infants with gastroschisis develop growth faltering by hospital discharge. To address this problem, we developed a nutrition pathway emphasizing (1) early provision of parenteral macronutrients, (2) use of human milk, and (3) growth faltering treatment. This study's goals were to assess adherence to and efficacy of this pathway in infants with gastroschisis across six California hospitals.

Methods

In 2015, the consortium standardized the care for infants with gastroschisis. To decrease growth faltering rates, between 2019 and 2020, nutrition guidelines were proposed, discussed, revised, and initiated. This study's primary outcome was weight or linear growth faltering (z score decline ≥0.8 in weight or length) at hospital discharge. Adherence measures were assessed.

Results

One hundred twenty-six infants with gastroschisis were born prepathway; 52 were born postpathway. Median gestational age was similar between cohorts. Adherence to components of the pathway ranged from 58% to 95%. The proportion of infants with weight or linear growth faltering at discharge was lower after pathway initiation (59.4% vs 36.2%, P = 0.0068). Adjusting for gestational age and fetal growth restriction, the pathway was associated with decreased weight or linear growth faltering (odds ratio [OR] 0.35 [0.16–0.75], P = 0.0060) and decreased linear growth faltering (OR 0.24 [0.096–0.56], P = 0.0062) at discharge. Hypertriglyceridemia, cholestasis, and days to full feeds were similar to published cohorts.

Conclusion

Fewer infants with gastroschisis experienced weight or length growth faltering at hospital discharge following the implementation of a multicenter nutrition pathway.

Abstract Image

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以共识为基础的营养路径与胃螺裂婴儿生长迟缓之间的关系：回顾性队列研究

背景：加利福尼亚大学胎儿联盟（University of California Fetal Consortium）公布，55% 的胃裂婴儿在出院时会出现生长迟缓。为了解决这个问题，我们开发了一种营养路径，强调（1）早期提供肠外宏量营养素，（2）使用人乳，以及（3）生长迟缓治疗。本研究的目标是评估加利福尼亚州六家医院对患有胃裂的婴儿采用该路径的依从性和有效性：2015 年，联合医院对患有胃裂的婴儿进行了标准化护理。为了降低生长迟缓率，在 2019 年至 2020 年期间，提出、讨论、修订并启动了营养指南。本研究的主要结果是出院时体重或线性生长迟缓（体重或身长的 Z 值下降≥0.8）。研究还对坚持治疗的措施进行了评估：126名患有胃裂的婴儿在路径前出生，52名在路径后出生。两组婴儿的中位胎龄相似。坚持路径的比例从58%到95%不等。启动路径后，出院时体重或线性生长迟缓的婴儿比例较低（59.4% vs 36.2%，P = 0.0068）。调整胎龄和胎儿生长受限因素后，出院时体重减轻或线性生长迟缓（几率比 [OR] 0.35 [0.16-0.75]，P = 0.0060）和线性生长迟缓（OR 0.24 [0.096-0.56]，P = 0.0062）与路径相关。高甘油三酯血症、胆汁淤积症和完全进食天数与已发表的队列相似：结论：实施多中心营养路径后，出院时出现体重或身长生长迟缓的胃螺裂婴儿减少了。

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来源期刊

Journal of Parenteral and Enteral Nutrition 医学-营养学

CiteScore

7.80

自引率

8.80%

发文量

161

审稿时长

6-12 weeks

期刊介绍： The Journal of Parenteral and Enteral Nutrition (JPEN) is the premier scientific journal of nutrition and metabolic support. It publishes original peer-reviewed studies that define the cutting edge of basic and clinical research in the field. It explores the science of optimizing the care of patients receiving enteral or IV therapies. Also included: reviews, techniques, brief reports, case reports, and abstracts.