Abstract 11537: Improved Variation in Interstage Weight Gain After the Norwood Operation: A Report From the National Pediatric Cardiology Quality Improvement Collaborative
Background: Growth failure is common in infants with a single ventricle. This study evaluated changes in infant growth among National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) sites caring for infants with single ventricle, following spread of nutritional best practices.
Methods: This was a retrospective analysis of NPC-QIC registry infants presenting for stage 2 surgical palliation (S2) at sites previously shown to have variation in interstage patient growth. The primary outcome variable was interstage weight-for-age z-score (WAZ) change between discharge from stage 1 palliation (S1) and S2. A Nutritional Bundle (home scales, outpatient dietician, weekly interstage contact with family, standardized post-S1 feeding evaluation) was spread among NPC-QIC sites at learning sessions and action period calls. Variation among sites in interstage WAZ changes was evaluated before (Period 1) and after (Period 2) changes in nutritional management using ANOVA with period, site, and period-by-site interaction. Chi-square/McNemar’s tests were used to compare percentages.
Results: 407 infants from 15 sites underwent S2 between 2008-2013: Period 1 (n=158)/Period 2 (n=249). Median age at S2 was 4.9 months (2.6 to 12.8) with no difference between periods. In Period 1 there was significant variation in interstage WAZ changes among sites (p=0.01), which was not observed in Period 2 (p = 0.39)(Figure). More patients had an interstage WAZ change < 0 in Period 1 (43%) than Period 2 (32%)(p<0.03). In Period 1, the median interstage WAZ change was <0 in 6 sites while in Period 2 no site had median interstage WAZ change <0 (p=0.03). Sites with the worst patient growth (Figure, sites 1-3) in Period 1 had marked improvement after changing their processes (p=0.02, 0.06, 0.06 respectively).
Conclusions: Spread of best nutritional practices led to decreased variation in interstage growth with most improvement observed at sites with the worst baseline growth outcomes.
- © 2013 by American Heart Association, Inc.