利用基于共识的营养通路- a随访研究改善先天性心脏病婴儿的生长

IF 6.6 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition Pub Date : 2025-03-28 DOI:10.1016/j.clnu.2025.03.012

Aneurin Young , Catarina Fandinga , Cai Davis , Esther Andrews , Mark J. Johnson , Tara Bharucha , R Mark Beattie , Luise V. Marino

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引用次数: 0

摘要

背景,先天性心脏病（CHD）是最常见的先天性异常，每1000个活产儿中就有9个患病。手术技术的进步大大提高了生存率，但生长衰竭与心脏手术后死亡风险增加有关。在等待手术期间改善CHD婴儿的生长是降低发病率和改善长期代谢结果的重要组成部分。2017年，在区域儿科心脏病服务中制定并实施了基于共识的营养途径。本研究的目的是在两个时期评估该途径在更大的冠心病婴儿队列中的影响：营养途径实施前（2013年1月- 2016年12月）和营养途径实施后（2017年1月- 2023年6月）。方法从电子病历中提取生长指标，计算z分数。建立平移旋转叠加模型（SITAR），拟合出两个时期的生长速度曲线。结果实施后组冠心病患儿在出生后4个月的生长情况明显改善。此外，在调整组差后，增重速度在实施后阶段显著高于对照组（p = 0.01）。在年龄较大的时间点，超重或肥胖儿童的患病率没有可检测到的变化，这表明干预并没有促进肥胖的发展，尽管随着队列年龄的增长，还需要进一步的分析。结论：与仅对营养不良给予营养支持的时期相比，术前为支持冠心病婴儿生长而制定的营养途径在出生后第一年的生长结果更好。在生命的第一年达到正常的生长模式可能有助于减少以后生活中代谢疾病的风险，尽管需要进一步的研究来阐明这一点。

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Improving the growth of infants with congenital heart disease using a consensus-based nutritional Pathway—A follow up study

Background & aims

Congenital Heart Disease (CHD) is the most common congenital abnormality, affecting 9 per 1000 live births. Advances in surgical techniques have significantly improved survival rates but growth failure is associated with increased risk of mortality post-cardiac surgery. Improving growth amongst infants with CHD whilst awaiting surgery is an important component to reducing morbidity as well as improving longer term metabolic outcomes. A consensus-based nutrition pathway was developed and implemented into a regional paediatric cardiology service in 2017. The aim of this study was to evaluate the impact of the pathway in a larger cohort of infants with CHD in two epochs: pre-nutrition pathway implementation (Jan 2013–Dec 2016) and post-nutrition pathway implementation (Jan 2017–June 2023).

Methods

Growth measures were extracted from electronic patient records and z-scores were calculated. SuperImposition by Translation And Rotation (SITAR) models were constructed to develop a single fitted curve of growth velocity for each of the two epochs.

Results

Infants with CHD in the post-implementation group achieved significantly better growth outcomes in the first 4-months of life. In addition, after adjustment for group differences, weight gain velocity was significantly higher in the post-implementation epoch (p = 0.01). There was no detectable change in the prevalence of overweight or obese children at older timepoints, suggesting that the intervention did not promote the development of obesity although further analysis will be required as the cohort gets older.

Conclusion

A nutrition pathway developed to support growth in infants with CHD before surgery was associated with better growth outcomes during the first year of life compared to an epoch when nutrition support was only given for malnourishment. Achieving normal growth patterns during the first year of life may help to reduce the risk of metabolic disease in later life, although further research will be required to elucidate this.

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来源期刊

Clinical nutrition 医学-营养学

CiteScore

14.10

自引率

6.30%

发文量

356

审稿时长

28 days

期刊介绍： Clinical Nutrition, the official journal of ESPEN, The European Society for Clinical Nutrition and Metabolism, is an international journal providing essential scientific information on nutritional and metabolic care and the relationship between nutrition and disease both in the setting of basic science and clinical practice. Published bi-monthly, each issue combines original articles and reviews providing an invaluable reference for any specialist concerned with these fields.