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Observational Study
. 2022 Jan;21(1):115-122.
doi: 10.1016/j.jcf.2021.08.005. Epub 2021 Aug 26.

Impact of guideline-recommended dietitian assessments on weight gain in infants with cystic fibrosis

Thida Ong  1 , Frankline M Onchiri  2 , Maria T Britto  3 , Sonya L Heltshe  4 , Larry G Kessler  5 , Michael Seid  6 , Bonnie W Ramsey  4
Affiliations
Observational Study

Impact of guideline-recommended dietitian assessments on weight gain in infants with cystic fibrosis

Thida Ong et al. J Cyst Fibros. 2022 Jan.

Abstract

Background: Cystic fibrosis (CF)-specialized nutrition care strives to meet normal infant growth, but the relationship of dietitian assessments to weight outcomes is unknown. We characterize nutrition management for inadequate weight gain and assess association of dietitian assessments and center-level weight-for-age Z-scores (WAZ).

Methods: We used encounter data from 226 infants across 28 US CF Centers from the Baby Observational Nutritional study between January 2012 through December 2017. We identified dietitian assessments and consensus guideline-recommended responses to inadequate weight gain: calorie increases, pancreatic enzyme replacement therapy (PERT) increases, or shortened time to next visit. We compared center assessments by funnel plot and summarize median WAZ by center.

Results: Of 2,527 visits, 808 (32%) visits had identified inadequate weight gain, distributed in 216 infants. Assessments occurred in 1953 visits (77%), but varied widely between centers (range 17% - 98%). For inadequate weight gain, most and least common responses were calorie increase (64%) and PERT increase (21%). Funnel plot analysis identified 4 high-performers for frequent dietitian assessments (range 92% - 98%) and 4 under-performers (range 17% - 56%). High-performers treated inadequate weight gain more often with adequate calories (24/30, 80% v. 12/23, 52%) and closer follow up (104/164, 63% v. 60/120, 49%) compared to under-performers. Three of 4 high-performing sites met center nutrition goals for positive median WAZ at 2 years old unlike 3 under-performers (WAZHigh 0.33 v. WAZLow -0.15), despite similar patient characteristics.

Conclusion: We characterized multicenter variation in dietitian assessments, identifying opportunities to improve care delivery to target early nutrition outcomes.

Keywords: Guideline adherence; Medical nutrition therapy; Newborn; Patient registry; Pediatric; Weight surveillance.

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Conflict of interest statement

Declaration of Competing interest Dr. Ong has received honoraria from Cincinnati Children's Hospital Medical Center to serve on the Cystic Fibrosis Foundation CF Learning Network Leadership Team. The other authors report no conflict of interest.

Figures

Figure 1.
Figure 1.. Funnel plot for center comparison of dietitian (RD) assessments.
Figure 2.
Figure 2.. Guideline-recommended practices for inadequate weight gain by performance group for dietitian assessments.
See this image and copyright information in PMC

References

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