bims-hylehe 2020-08-30 papers

Issue of 2020–08–30
five papers selected by
Richard James, University of Pennsylvania

J Pediatr. 2020 Aug 19. pii: S0022-3476(20)31025-8. [Epub ahead of print]

A Multi-Interventional Nutrition Program for Newborns with Congenital Heart Disease.

Patrick O'Neal Maynord, Melissa Johnson, Meng Xu, James C Slaughter, Stacy A S Killen.

OBJECTIVE: To evaluate how outcomes changed in newborns undergoing surgery for congenital heart disease (CHD) after implementation of a standardized pre- and post-operative nutrition program.
STUDY DESIGN: We performed a single-center cohort study of newborns who underwent cardiac surgery between September 2008 and July 2015. We evaluated growth and feeding outcomes in the 2 years of pre-program time (phase 0), in the 2 years after initiation of a post-operative feeding algorithm (phase 1), and in the 2 years following introduction of a pre-operative feeding program (phase 2) using traditional statistics and quality improvement methods.
RESULTS: The study included 570 newborns with CHD. Weight-for-age z-score change from birth to hospital discharge significantly improved from phase 0 (-1.02 [IQR -1.45 to -0.63]) to phase 1(-0.83 [IQR -1.25 to -0.54]; p=0.006), with this improvement maintained in phase 2 (-0.89 [IQR -1.30 to -0.56]; P = .017 across phases). Gastrostomy (G)-tube utilization declined significantly (25% in phase 0 versus 12% and 14% in phases 1 and 2; p<0.001) and pre-operative enteral feeding increased significantly (47% and 46% in phases 0 and 1 versus 76% in phase 2; p<0.001) without increases in necrotizing enterocolitis (NEC), hospital stay, or mortality.
CONCLUSIONS: Introduction of a multi-interventional nutrition program was associated with improved weight gain, fewer gastrostomy-tubes at hospital discharge, and increased pre-operative enteral feeding without increases in NEC, hospital stay, or mortality.

DOI: https://doi.org/10.1016/j.jpeds.2020.08.039

Ann Thorac Surg. 2020 Aug 24. pii: S0003-4975(20)31354-0. [Epub ahead of print]

Cardiac biomarkers associated with hospital length of stay after pediatric congenital heart surgery.

Michael D Green, Devin M Parker, Allen D Everett, Luca Vricella, Marshall L Jacobs, Jeffrey P Jacobs, Jeremiah R Brown.

BACKGROUND: Prolonged hospital length of stay after congenital heart surgery is a significant cost burden and associated with post-operative morbidity. Our goal was to evaluate the association between pre- and post-operative biomarker levels and in-hospital length of stay for children after congenital heart surgery.
METHODS: We enrolled patients <18 years of age who underwent at least 1 congenital heart operation at Johns Hopkins Hospital from 2010-2014. Blood samples were collected before the index operation and at the end of the bypass. ST2 and NT-proBNP measurements were evaluated as log-transformed, median and tercile cutpoints. We evaluated the association between pre- and postoperative NT-proBNP and ST2 measurements with in-hospital postoperative length of stay using multivariate logistic regression. We adjusted for covariate risks using a version of the Society of Thoracic Surgeons congenital heart surgery mortality risk model.
RESULTS: In our cohort, 45% of our patients had an in-hospital postoperative length of stay longer than the median. Before adjustment, preoperative NT-proBNP above the population median and the highest tercile exhibited a significantly longer in-hospital length of stay. After adjustment for covariates in the risk model, pre- and post-operative ST2 and NT-proBNP demonstrated a significantly longer length of stay.
CONCLUSIONS: Peri-operative ST2 and NT-proBNP had a significant association with increased postoperative in-hospital length of stay before and after adjustment. ST2 in particular could be used to guide an earlier assessment of patient risk for complications which may lead to adverse outcomes.

Keywords: biomarkers; outcomes; pediatric congenital heart disease; postoperative care; prediction

DOI: https://doi.org/10.1016/j.athoracsur.2020.06.059

World J Pediatr Congenit Heart Surg. 2020 Aug 26. 2150135120949462

Early Impact of the COVID-19 Pandemic on Congenital Heart Surgery Programs Across the World: Assessment by a Global Multi-Societal Consortium.

COVID-19 International Congenital Heart Surgery Taskforce

The coronavirus disease 2019 (COVID-19) pandemic currently gripping the globe is impacting the entire health care system with rapidly escalating morbidities and mortality. Although the infectious risk to the pediatric population appears low, the effects on children with congenital heart disease (CHD) remain poorly understood. The closure of congenital heart surgery programs worldwide to address the growing number of infected individuals could have an unintended impact on future health for COVID-19-negative patients with CHD. Pediatric and congenital heart surgeons, given their small numbers and close relationships, are uniquely positioned to collectively assess the impact of the pandemic on surgical practice and care of children with CHD. We present the results of an international survey sent to pediatric and congenital heart surgeons characterizing the early impact of COVID-19 on the care of patients with CHD.

Keywords: congenital heart disease (CHD); congenital heart surgery; morbidity); outcomes (includes mortality; pediatric

DOI: https://doi.org/10.1177/2150135120949462

J Pediatr Nurs. 2020 Aug 19. pii: S0882-5963(20)30564-9. [Epub ahead of print]

Nurses' perceptions of rooming-in for caregivers of infants with CCHD.

Jenna Shackleford, Rebecca Chambers, Jennifer Nelson, Megan Scott, Susan Brasher.

Congenital heart disease (CHD) is the most common congenital defect. Infants with critical congenital heart disease (CCHD) require complex medical care, and their caregivers need extensive training before being discharged home to safely care for their child. The rooming-in process provides caregivers with an opportunity to learn, practice, and manage the skills required for discharge to home during hospitalization. Although the literature reflects positive implications for the use of the rooming-in process in other populations (e.g., neonatal abstinence syndrome), literature about the rooming-in process in a pediatric cardiac care setting is limited. There remains a gap in the literature pertaining to the viewpoints of nurses, specifically as it relates to implementing a rooming-in process. Therefore, a qualitative study design was chosen to explore the nurses' perceptions of the rooming-in process using focus groups. The purpose of this study was to gain insight from nurses as to strategies to enhance the rooming-in process for caregivers of infants with CCHD. Additionally, we explored potential education and interventions to improve outcomes for infants with CCHD preparing to be discharged home.

Keywords: Congenital heart defect; Congenital heart disease; Discharge planning; Qualitative research; Rooming in care

DOI: https://doi.org/10.1016/j.pedn.2020.08.008

J Cardiovasc Nurs. 2020 Aug 24.

Parents' Experiences of Transition From Hospital to Home After Their Infant's First-Stage Cardiac Surgery: Psychological, Physical, Physiological, and Financial Survival.

Kerry L Gaskin, David Barron, Jo Wray.

BACKGROUND: The intersurgical stage is a critical time for fragile infants with complex congenital heart disease, but little is known about the impact on parents.
OBJECTIVE: The aim of this study was to explore parents' experiences of the transition from hospital to home with their infant after stage 1 cardiac surgery for complex congenital heart disease.
METHOD: This is a prospective, longitudinal, mixed methods feasibility study using semistructured interviews and self-report instruments at 4 time points: before discharge (baseline), 2 weeks post discharge, 8 weeks post discharge, and after stage 2 surgery. Qualitative data were analyzed thematically; and quantitative data, descriptively.
RESULTS: Sixteen parents of 12 infants participated. All parents described signs of acute stress disorder; 4 parents described symptoms of posttraumatic stress disorder before discharge. Parents' fear and uncertainty about going home were multifaceted, underpinned by exposure to numerous traumatic events. By 8 weeks post discharge, parents' feelings and emotions were positive, relieved, and relaxed. Mean generalized anxiety and depression scores were higher before discharge; most individual anxiety and depression scores decreased over time. Physiological survival included self-care needs, such as eating and sleeping properly. Physical survival included preparation of the home environment and home alterations adapting to their infant's equipment needs. Financial survival was a burden, particularly for those unable to return to work.
CONCLUSION: Patterns of experience in surviving the transition included psychological, physical, physiological, and financial factors. Authors of further longitudinal research could test the effectiveness of psychological preparation interventions, while encouraging early consideration of the other factors influencing parents' care of their infant after discharge from hospital.

DOI: https://doi.org/10.1097/JCN.0000000000000727