The development of a consensus-based nutritional pathway for infants with CHD before surgery using a modified Delphi process

Luise V Marino, Mark J Johnson, Nigel J Hall, Natalie J Davies, Catherine S Kidd, M Lowri Daniels, Julia E Robinson, Trevor Richens, Tara Bharucha, Anne-Sophie E Darlington, British Dietetic Association Paediatric Cardiology Interest Group, Luise V Marino, Mark J Johnson, Nigel J Hall, Natalie J Davies, Catherine S Kidd, M Lowri Daniels, Julia E Robinson, Trevor Richens, Tara Bharucha, Anne-Sophie E Darlington, British Dietetic Association Paediatric Cardiology Interest Group

Abstract

IntroductionDespite improvements in the medical and surgical management of infants with CHD, growth failure before surgery in many infants continues to be a significant concern. A nutritional pathway was developed, the aim of which was to provide a structured approach to nutritional care for infants with CHD awaiting surgery.Materials and methodsThe modified Delphi process was development of a nutritional pathway; initial stakeholder meeting to finalise draft guidelines and develop questions; round 1 anonymous online survey; round 2 online survey; regional cardiac conference and pathway revision; and final expert meeting and pathway finalisation.

Results: Paediatric Dietitians from all 11 of the paediatric cardiology surgical centres in the United Kingdom contributed to the guideline development. In all, 33% of participants had 9 or more years of experience working with infants with CHD. By the end of rounds 1 and 2, 76 and 96% of participants, respectively, were in agreement with the statements. Three statements where consensus was not achieved by the end of round 2 were discussed and agreed at the final expert group meeting.

Conclusions: Nutrition guidelines were developed for infants with CHD awaiting surgery, using a modified Delphi process, incorporating the best available evidence and expert opinion with regard to nutritional support in this group.

Keywords: CHD; Delphi; growth; infants; nutrition.

Figures

Figure 1
Figure 1
Process followed during modified Delphi consensus.
Figure 2
Figure 2
Nutritional pathway for infants with CHD before surgery. Nutrition Care Plan A, B, and C describe a package of nutritional care, in addition to exit criteria for dietetic and speech and language therapist (SLT) support (full nutritional pathway available in Supplementary material 3).
Figure 3
Figure 3
Step 5: Choosing a nutrition care plan: A, B or C (full nutritional pathway available in Supplementary material 3).

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