目的:评价单室先天性心脏病患儿的营养状况及早期营养摄入情况。
方法:纳入的婴儿在出生后的前6周内接受了诺伍德手术或混合干预(第一阶段),2014年1月至2019年1月,在克鲁姆林的爱尔兰儿童健康中心。人口统计,人体测量学,营养摄入,并收集发病率数据。
结果:收集了90名婴儿和1886名新生儿入院日的数据。出生时测量之间的年龄平均体重z评分(WAZ)显着下降,-0.01,1期手术后出院-1.45(P<0.01)。出院时(中位住院时间,25天)32%的婴儿WAZ<-2,11%的婴儿WAZ<-3。第一阶段前,26%接受营养饲料,39%接受肠外营养。在56%和13%的入院日均满足基础代谢需求和目标热量摄入(120kcal/kg)。分别。提到营养师的婴儿获得任何形式的营养支持的时间较短,肠内喂养,和目标热量摄入(分别为P<.001,P=.016和P=.048)。在第3阶段(Fontan)手术中,15%的婴儿被归类为发育不良(年龄长度z评分[LAZ]<-2)。
结论:营养状况的最大下降发生在新生儿期,其次是Fontan程序的时间显着生长迟缓。营养师的早期参与对于这个营养脆弱的群体的护理至关重要。目前术前营养支持率较低,在这个关键阶段,可能有机会改善摄入量。
OBJECTIVE: To evaluate the nutritional status and early nutritional intake of infants with univentricular congenital heart disease.
METHODS: The included infants underwent a Norwood procedure or hybrid intervention (stage 1) within the first 6 weeks of life, between January 2014 and January 2019, at Children\'s Health Ireland at Crumlin. Demographic, anthropometric, nutritional intake, and morbidity data were collected.
RESULTS: Data were collected on 90 infants and 1886 neonatal admission days. There was a significant drop in mean weight-for-age z-score (WAZ) between measurements at birth, -0.01 and on discharge post stage 1 surgery -1.45 (P < .01). On hospital discharge (median hospital stay, 25 days) 32% of infants had a WAZ <-2 and 11% had a WAZ <-3. Pre-stage 1, 26% received trophic feeds and 39% received parenteral nutrition. Basal metabolic requirements and target caloric intake (120 kcal/kg) were met on 56% and 13% of admission days, respectively. Infants referred to a dietitian had a shorter time to any form of nutrition support, enteral feeds, and target caloric intake (P < .001, P = .016, and P = .048, respectively). At stage 3 (Fontan) surgery, 15% of infants were classified as stunted (length-for-age z-score [LAZ] <-2).
CONCLUSIONS: The greatest decline in nutritional status occurs in the neonatal period, followed by significant growth stunting by the time of the Fontan procedure. Early involvement of dietitians is critical in the care of this nutritionally fragile group. With the currently low rate of preoperative nutritional support, there may be opportunities to improve intake at this critical stage.