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Clinical audit results in earlier nutritional intervention in malnourished children with cystic fibrosis with improved outcome
Author(s) -
Ledder Oren,
Oliver Mark R,
Heine Ralf G,
Graham Joanne,
Volders Evelyn,
Robinson Philip J
Publication year - 2015
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/jpc.12888
Subject(s) - medicine , gastrostomy , referral , cystic fibrosis , cohort , pediatrics , enteral administration , weight loss , malnutrition , psychological intervention , parenteral nutrition , surgery , obesity , family medicine , psychiatry
Aim The association between nutritional status, pulmonary function and survival in cystic fibrosis ( CF ) is well established. A previous case series from the R oyal C hildren's H ospital, M elbourne ( RCH ), demonstrated suboptimal referral practices and highlighted the importance of early nutritional interventions in children with CF . Various qualitative changes were made to our CF service, and this study assesses the effects of these practice changes timing of gastrostomy and clinical outcome in patients who underwent gastrostomy insertion. Method Clinical audit of all CF patients who had undergone gastrostomy insertion from 2002 to 2010 at R oyal C hildren's H ospital. Clinical data, including nutritional parameters, respiratory function and survival, were collected at 2 years prior and 2 years post gastrostomy insertion. Data were compared with the previous study from 1989 to 1997. Results Patients with CF who underwent gastrostomy insertion between 2002 and 2010 ( n = 22) had higher weight‐for‐age scores (−1.5 ± 0.68 vs. −2.67 ± 1.06; P = 0.0001) and higher forced expiratory volume in 1 s (68% ± 22 vs. 52% ± 18.5; P = 0.006), compared with the cohort from 1989 to 1997 ( n = 37). These differences were maintained at 2‐year follow‐up. P seudomonas aeruginosa colonisation rate was 100% in 1989–1997 vs. 41% in 2002–2010; P = 0.0001. The 2‐year survival post‐gastrostomy insertion improved from 70% to 100%; P = 0.004. Conclusion Earlier referral of patients in the recent cohort resulted in sustained improvements in weight‐for‐age and lung function. Survival at 2 years post‐procedure was significantly improved. This study confirms the value of clinical audits and subsequent re‐evaluation of clinical services.