Feeding infants with complex congenital heart disease: a modified Delphi survey to examine potential research and practice gaps

Elgersma, Kristin M.; McKechnie, Anne Chevalier; Gallagher, Tiffany T.; Trebilcock, Anna L; Pridham, Karen F.; Spatz, Diane L.

doi:10.1017/s1047951120004370

Cited by 15 publications

(24 citation statements)

References 78 publications

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“…The omission of HM/BF from the CHD gut microbiome literature is not entirely surprising as support for HM/BF in the CHD population has been historically inadequate and under prioritized by the healthcare team, 14,[70][71][72] contributing to extremely low prevalence of these feeding practices. 12 We also speculate that, as the underlying cause of cardiac NEC may be different than in preterm infants, some providers might assume that HM is not similarly protective for infants with CHD.…”

Section: Potential Mechanismsmentioning

confidence: 99%

Human milk feeding and direct breastfeeding improve outcomes for infants with single ventricle congenital heart disease: Propensity score matched analysis of the NPC-QIC registry

Elgersma

Wolfson

Fulkerson

et al. 2023

Preprint

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Background: Infants with single ventricle (SV) congenital heart disease (CHD) undergo three staged surgeries/interventions, with risk for morbidity and mortality. We estimated the effect of human milk (HM) and direct breastfeeding (BF) on outcomes including necrotizing enterocolitis (NEC), infection-related complications, length of stay (LOS), and mortality. Methods: We analyzed the National Pediatric Cardiology Quality Improvement Collaborative registry (2016?2021), examining HM/BF groups during stage 1 (S1P) and stage 2 (S2P) palliations. We calculated propensity scores for feeding exposures, then fitted Poisson and logistic regression models to compare outcomes between propensity-matched cohorts. Results: Participants included 2491 infants (68 sites). Estimates for all outcomes were better in HM/BF groups. Infants fed exclusive HM before S1P had lower odds of preoperative NEC (OR=0.37, 95% CI=0.17?0.84, p=0.017) and shorter S1P LOS (RR=0.87, 0.78?0.98, p=0.027). During the S1P hospitalization, infants with high HM had lower odds of postoperative NEC (OR=0.28, 0.15?0.50, p<0.001) and sepsis (0.29, 0.13?0.65, p=0.003), and shorter S1P LOS (RR=0.75, 0.66?0.86, p<0.001). At S2P, infants with any HM (0.82, 0.69?0.97, p=0.018) and any BF (0.71, 0.57?0.89, p=0.003) experienced shorter LOS. Conclusions: Infants with SV CHD in high HM and BF groups experienced multiple significantly better outcomes. Given our findings of improved health, strategies to increase the rates of HM/BF in these patients should be implemented. Future research should replicate these findings with granular feeding data and in broader CHD populations, and should examine mechanisms (eg, HM components; microbiome) by which HM/BF benefits these infants.

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Section: Potential Mechanismsmentioning

confidence: 99%

Human milk feeding and direct breastfeeding improve outcomes for infants with single ventricle congenital heart disease: Propensity score matched analysis of the NPC-QIC registry

Elgersma

Wolfson

Fulkerson

et al. 2023

Preprint

Self Cite

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“…The aim of which is to convert individual opinions into group consensus, based on the premise that consensus of a group is more accurate than those of the individual. This ensures there is transparency regarding areas of consensus and non-consensus [18,19,21]. The modified Delphi method used in this study, to develop the Pedi-R-MAPP comprised of ten steps [18e21] (Fig.…”

Section: Modified Delphi Consensusmentioning

confidence: 99%

Pedi-R-MAPP: The development of a nutritional awareness tool for use in remote paediatric consultations using a modified Delphi consensus

et al. 2022

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Background & aims: The Remote Malnutrition Application (R-MAPP) was developed during the COVID-19 pandemic to provide support for health care professionals (HCPs) working in the community to complete remote nutritional assessments, and provide practical guidance for nutritional care. The aim of this study was to modify the R-MAPP into a version suitable for children, Pediatric Remote Malnutrition Application (Pedi-R-MAPP), and provide a structured approach to completing a nutrition focused assessment as part of a technology enabled care service (TECS) consultation. Methods: A ten-step process was completed: 1) permission to modify adult R-MAPP, 2) literature search to inform the Pedi-R-MAPP content, 3) Pedi-R-MAPP draft, 4) international survey of HCP practice using TECS, 5) nutrition experts invited to participate in a modified Delphi process, 6) first stakeholder meeting to agree purpose/draft of the tool, 7) round-one online survey, 8) statements with consensus removed from survey, 9) round-two online survey for statements with no consensus and 10) second stakeholder meeting with finalisation of the Pedi-R-MAPP nutrition awareness tool. Results: The international survey completed by 463 HCPs, 55% paediatricians, 38% dietitians, 7% nurses/ others. When HCPs were asked to look back over the last 12 months, dietitians (n ¼ 110) reported that 5.7 ± 10.6 out of every 10 appointments were completed in person; compared to paediatricians (n ¼ 182) who reported 7.5 ± 7.0 out of every 10 appointments to be in person (p < 0.0001), with the remainder completed as TECS consultations.

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“…4 Additionally, there is poor consensus regarding clinical practice to support breastfeeding in this population. 60…”

Section: Breastfeedingmentioning

confidence: 99%

Assessment and management of feeding difficulties for infants with complex CHD

et al. 2022

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Early surgical intervention in infants with complex CHD results in significant disruptions to their respiratory, gastrointestinal, and nervous systems, which are all instrumental to the development of safe and efficient oral feeding skills. Standardised assessments or treatment protocols are not currently available for this unique population, requiring the clinician to rely on knowledge based on neonatal literature. Clinicians need to be skilled at evaluating and analysing these systems to develop an appropriate treatment plan to improve oral feeding skill and safety, while considering post-operative recovery in the infant with complex CHD. Supporting the family to re-establish their parental role during the hospitalisation and upon discharge is critical to reducing parental stress and oral feeding success.

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Feeding infants with complex congenital heart disease: a modified Delphi survey to examine potential research and practice gaps

Cited by 15 publications

References 78 publications

Human milk feeding and direct breastfeeding improve outcomes for infants with single ventricle congenital heart disease: Propensity score matched analysis of the NPC-QIC registry

Human milk feeding and direct breastfeeding improve outcomes for infants with single ventricle congenital heart disease: Propensity score matched analysis of the NPC-QIC registry

Pedi-R-MAPP: The development of a nutritional awareness tool for use in remote paediatric consultations using a modified Delphi consensus

Assessment and management of feeding difficulties for infants with complex CHD

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