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

• Published in: Journal of cystic fibrosis 2022-01, Vol.21 (1), p.115-122
• Main Authors: Ong, Thida, Onchiri, Frankline M., Britto, Maria T., Heltshe, Sonya L., Kessler, Larry G., Seid, Michael, Ramsey, Bonnie W.
• Format: Article
• Language: English
• Subjects: Child, Preschool; Cystic Fibrosis - diet therapy; Female; Guideline Adherence; Humans; Infant; Longitudinal Studies; Male; Medical nutrition therapy; Newborn; Nutrition Assessment; Nutrition Therapy - methods; Nutritional Status; Patient registry; Pediatric; Prospective Studies; Weight Gain; Weight surveillance
• ISSN: 1569-1993; 1873-5010
• DOI: 10.1016/j.jcf.2021.08.005

•A third of visits for 216 infants had inadequate weight gain from the prior visit.•High RD-supported sites gave infants high calories more than less RD-supported sites.•Centers with the most frequent RD visits more likely had goal center weight-for-age. 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.