Details

Autor(en) / Beteiligte

• Anderson, Jeffrey B.
• Beekman III, Robert H.
• Kugler, John D.
• Rosenthal, Geoffrey L.
• Jenkins, Kathy J.
• Klitzner, Thomas S.
• Martin, Gerard R.
• Neish, Steven R.
• Darbie, Lynn
• King, Eileen
• Lannon, Carole

Titel

Use of a Learning Network to Improve Variation in Interstage Weight Gain after the Norwood Operation

Ist Teil von

• Congenital heart disease, 2014-11, Vol.9 (6), p.512-520

Ort / Verlag

United States: Blackwell Publishing Ltd

Erscheinungsjahr

2014

Quelle

Wiley Online Library - AutoHoldings Journals

Beschreibungen/Notizen

• Background Growth failure is common in infants with single ventricle. This study evaluated the use of a learning network, the National Pediatric Cardiology Quality Improvement Collaborative (NPC‐QIC), to spread optimized nutritional practices and improve infant growth. Methods A previously identified Nutritional Bundle was spread among NPC‐QIC sites. Primary outcome: interstage weight‐for‐age z‐score change (ΔWAZ) between discharge from stage 1 palliation (S1) and stage 2 surgical palliation (S2). Variation among sites in interstage ΔWAZ was evaluated before (Period 1) and after (Period 2) spread of Nutritional Bundle. We performed an analysis of NPC‐QIC registry infants presenting for S2 at sites previously shown to have significant variation in interstage patient growth. Results Four hundred seven infants from 15 sites underwent S2 between 2008 and 2013: 158 in Period 1 (December 2008–December 2010) and 249 in Period 2 (December 2010–April 2013). Median age at S2 was 4.9 months (2.6–12.8) with no difference between periods. There was significant variation in interstage ΔWAZ among sites in Period 1 (P = .01) but not in Period 2 (P = .39). More patients had an interstage ΔWAZ <0 in Period 1 (43%) than Period 2 (32%) (P = .03). In Period 1, the median interstage ΔWAZ was <0 in six sites while in Period 2 no site had median interstage ΔWAZ <0. Sites with the worst patient growth in Period 1 had marked improvement in Period 2 (P = .02, .06, and .06, respectively). Conclusions Spread of optimal nutritional practices led to decreased variation in interstage growth with most improvement observed at sites with the worst baseline growth outcomes.