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The Nutrition, Feeding and Swallowing Program
SUNDAY, NOVEMBER 7
POSTER SESSION: PROFESSIONAL SKILLS; NUTRITION ASSESSMENT; MEDICAL NUTRITION THERAPY The Effects of Nutritional Goals on Weight Status among Very Low Birth Weight and Extremely Low Birth Weight Infants
Food Journal Writing in a Family-Based Youth Weight Management Program
Author(s): G. Cunha, P. Rothpletz-Puglia, J. Ziegler, J. Parrott, R. Touger-Decker; UMDNJ, Newark, NJ
Author(s): J. E. Fisher,1 E. Kennedy2; 1Nutrition Therapy, Cleveland Clinic, Independence, OH, 2Pediatric Institute, Cleveland Clinic, Independence, OH
Learning Outcome: To indicate if significant differences in growth using weight-for-age z-score were found between very low birth weight and extremely low birth weight infants after controlling for nutrition goal achievement. Objective: To evaluate growth changes in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants meeting three nutrition goals compared to those not meeting nutrition goals. Methods/Design: Retrospective chart review of ELBW and VLBW infants (n⫽100) from a level III neonatal unit, born appropriate for gestational age, meeting inclusion and exclusion criteria. Data were analyzed using SPSSv17.0. Frequency distributions reported demographic and clinical characteristics and nutrition goals. T-tests were used to analyze the change in z-scores and differences between ELBW and VLBW infants. A repeated measures factorial ANOVA was used to analyze the effect of nutrition goal achievement and weight group on growth change at each time period. Results: Of 110 infant records reviewed: 29 were ELBW (26.30%) and 81 were VLBW (73.60%) infants. The mean weight-for-age z-score at birth was -0.03 for both groups. For the total sample, day of life 28 z-score was -0.97 and -0.99 at discharge. For the total sample, 44.50% (n⫽49) met all three nutrition goals; 24.10% (n⫽7) were ELBW infants and 51.90% (n⫽42) were VLBW infants. No significant differences in growth were found between ELBW and VLBW infants even after controlling for nutrition goal achievement. Conclusions: ELBW and VLBW infants had comparable growth even after controlling for nutrition goal achievement. Nutrition goals may need to be more aggressive to promote weight gain closer to intrauterine growth rates. Though, in this study, the rate of extra-uterine growth restriction at discharge was lower than observed in most studies.
Learning Outcome: The registered dietitian will learn the effectiveness of children and teenagers keeping a food journal when enrolled in a family-based weight management program. The relationship between completion of a food journal and weight loss in children and teens was evaluated. Children ages 7-18 with a BMI percentile of ⱖ95 by age and gender were recruited for a 10week group family-based youth weight management program from April 2005 to June 2008. The participants recorded a weekly food journal. Study subjects attended five or more classes out of the 10 week sequence. A registered dietitian determined weekly completion of 75 subjects’ food journals by identifying recordings of foods eaten for four days or more of each week. The association between food journal completion, program attendance, and weight loss (as defined by weight loss, percent of weight lost, and BMI lost) was assessed with the Spearman correlation coefficient. The mean weight loss during the program was 1.9 pounds, ranging from 3.3 pounds gained to 11.6 pounds lost. Mean BMI lost was 1.0 kg/m2. Subjects attended a median of 9 weeks and completed journals a median of 5 weeks. The associations between the number of weeks attended and weight loss, percent weight loss, and BMI loss were marginally significant and weak (P⬍0.08 and correlation ⫽0.2 for each). However, the associations between the number of journals completed and weight loss, percent weight loss, and BMI loss were significant and moderately strong. (P⬍0.001 and correlation⫽0.5 for each). Scatterplots suggested larger weight losses if at least 6 weeks of journals were completed. Completion of journals is associated with better outcomes and should be emphasized along with program attendance. Funding Disclosure: None
Funding Disclosure: None
Role of the Registered Dietitian (RD) in an Interdisciplinary Cleft Team Author(s): M. Brodie; Clinical Nutrition, Arkansas Children’s Hospital, Little Rock, AR Learning Outcome: The participant will be able to name two feeding and /or growth goals for children followed by an Interdisciplinary Cleft team. Infants born with Cleft Lip and/or Cleft Palate have potential for feeding problems. Without appropriate intervention, inadequate growth may delay surgical repair. All Cleft Palate patients should be followed by an accredited cleft team. An R.D. is a vital member of this interdisciplinary team. An R.D. assessment at the first clinic visit establishes feeding and growth goals. Specialized feeding bottles with one-way valves are a critical component of the feeding plan. During the first months of life, parents, home health nurses or local physicians communicate weekly weights to the R.D. If growth goals are not met, the caloric concentration of expressed breast milk or infant formula and/or the feeding goals will be adjusted. Feeding skills and growth are monitored throughout the first year of life. At six to seven years of age, these patients begin to meet with the entire Interdisciplinary Cleft Team for an annual visit. Many of these children will begin orthodontic treatment in preparation for bone grafting. The R.D. provides guidelines for progression from a liquidsonly diet to a soft-non-chewing diet, which is essential for several weeks after the surgery. If bone grafting in not scheduled, the R.D. assesses the usual dietary intake and growth pattern and makes recommendations for improvement. Educational materials presented to families during the first clinic visit following birth and for bone graft surgery will be available for review. Funding Disclosure: None
The Nutrition, Feeding and Swallowing Program Author(s): H. L. Weiss,1 K. Lovely,1 J. Mikami2; 1Nutrition, Feeding, and Swallowing Program, Child Health Services, Manchester, NH, 2 Nutrition, Feeding, and Swallowing Program, SERESC, Bedford, NH Learning Outcome: To explore alternative options for serving children and youth with special health care needs. The Nutrition, Feeding and Swallowing Program recognize the unique requirements of children with special health care needs in the community. Our agency has a team of dietitians and feeding & swallowing providers who make home visits throughout the state of New Hampshire. The providers, referred to as the Nutrition, Feeding and Swallowing Program, are employed by a collaborative agency between Child Health Services, SERESC and the State of New Hampshire. They typically conduct 1-4 nutrition and/or feeding & swallowing evaluations and follow ups annually per client. A dietitians and/or a feeding & swallowing provider join parents, physicians and other community service providers to create a coordinated feeding team for each child. The benefits of home based nutrition care center include observations that a trained nutritionist can make during mealtime at home in a more relaxed setting than during office visits. Recommendations can be tailored to the unique family environment taking into account family dynamics (child/sibling, parent/child interactions), meal schedules, and family meal culture. There is also a unique opportunity to reinforce recommendations made during mealtime. This defined nutritional intervention can ease the sense of being overwhelmed by information which families can experience at a regular office/clinic visit. If the patient does not have medical insurance that covers these services, the Nutrition, Feeding, and Swallowing Program will cover these services for them, regardless of income. We believe home nutrition visits should be explored as an option to enhance current approaches to serving children with special health care needs. Funding Disclosure: None
A-36 / September 2010 Suppl 2—Abstracts Volume 110 Number 9
POSTER SESSION: PROFESSIONAL SKILLS; NUTRITION ASSESSMENT; MEDICAL NUTRITION THERAPY The Effects of Nutritional Goals on Weight Status among Very Low Birth Weight and Extremely Low Birth Weight Infants
Food Journal Writing in a Family-Based Youth Weight Management Program
Author(s): G. Cunha, P. Rothpletz-Puglia, J. Ziegler, J. Parrott, R. Touger-Decker; UMDNJ, Newark, NJ
Author(s): J. E. Fisher,1 E. Kennedy2; 1Nutrition Therapy, Cleveland Clinic, Independence, OH, 2Pediatric Institute, Cleveland Clinic, Independence, OH
Learning Outcome: To indicate if significant differences in growth using weight-for-age z-score were found between very low birth weight and extremely low birth weight infants after controlling for nutrition goal achievement. Objective: To evaluate growth changes in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants meeting three nutrition goals compared to those not meeting nutrition goals. Methods/Design: Retrospective chart review of ELBW and VLBW infants (n⫽100) from a level III neonatal unit, born appropriate for gestational age, meeting inclusion and exclusion criteria. Data were analyzed using SPSSv17.0. Frequency distributions reported demographic and clinical characteristics and nutrition goals. T-tests were used to analyze the change in z-scores and differences between ELBW and VLBW infants. A repeated measures factorial ANOVA was used to analyze the effect of nutrition goal achievement and weight group on growth change at each time period. Results: Of 110 infant records reviewed: 29 were ELBW (26.30%) and 81 were VLBW (73.60%) infants. The mean weight-for-age z-score at birth was -0.03 for both groups. For the total sample, day of life 28 z-score was -0.97 and -0.99 at discharge. For the total sample, 44.50% (n⫽49) met all three nutrition goals; 24.10% (n⫽7) were ELBW infants and 51.90% (n⫽42) were VLBW infants. No significant differences in growth were found between ELBW and VLBW infants even after controlling for nutrition goal achievement. Conclusions: ELBW and VLBW infants had comparable growth even after controlling for nutrition goal achievement. Nutrition goals may need to be more aggressive to promote weight gain closer to intrauterine growth rates. Though, in this study, the rate of extra-uterine growth restriction at discharge was lower than observed in most studies.
Learning Outcome: The registered dietitian will learn the effectiveness of children and teenagers keeping a food journal when enrolled in a family-based weight management program. The relationship between completion of a food journal and weight loss in children and teens was evaluated. Children ages 7-18 with a BMI percentile of ⱖ95 by age and gender were recruited for a 10week group family-based youth weight management program from April 2005 to June 2008. The participants recorded a weekly food journal. Study subjects attended five or more classes out of the 10 week sequence. A registered dietitian determined weekly completion of 75 subjects’ food journals by identifying recordings of foods eaten for four days or more of each week. The association between food journal completion, program attendance, and weight loss (as defined by weight loss, percent of weight lost, and BMI lost) was assessed with the Spearman correlation coefficient. The mean weight loss during the program was 1.9 pounds, ranging from 3.3 pounds gained to 11.6 pounds lost. Mean BMI lost was 1.0 kg/m2. Subjects attended a median of 9 weeks and completed journals a median of 5 weeks. The associations between the number of weeks attended and weight loss, percent weight loss, and BMI loss were marginally significant and weak (P⬍0.08 and correlation ⫽0.2 for each). However, the associations between the number of journals completed and weight loss, percent weight loss, and BMI loss were significant and moderately strong. (P⬍0.001 and correlation⫽0.5 for each). Scatterplots suggested larger weight losses if at least 6 weeks of journals were completed. Completion of journals is associated with better outcomes and should be emphasized along with program attendance. Funding Disclosure: None
Funding Disclosure: None
Role of the Registered Dietitian (RD) in an Interdisciplinary Cleft Team Author(s): M. Brodie; Clinical Nutrition, Arkansas Children’s Hospital, Little Rock, AR Learning Outcome: The participant will be able to name two feeding and /or growth goals for children followed by an Interdisciplinary Cleft team. Infants born with Cleft Lip and/or Cleft Palate have potential for feeding problems. Without appropriate intervention, inadequate growth may delay surgical repair. All Cleft Palate patients should be followed by an accredited cleft team. An R.D. is a vital member of this interdisciplinary team. An R.D. assessment at the first clinic visit establishes feeding and growth goals. Specialized feeding bottles with one-way valves are a critical component of the feeding plan. During the first months of life, parents, home health nurses or local physicians communicate weekly weights to the R.D. If growth goals are not met, the caloric concentration of expressed breast milk or infant formula and/or the feeding goals will be adjusted. Feeding skills and growth are monitored throughout the first year of life. At six to seven years of age, these patients begin to meet with the entire Interdisciplinary Cleft Team for an annual visit. Many of these children will begin orthodontic treatment in preparation for bone grafting. The R.D. provides guidelines for progression from a liquidsonly diet to a soft-non-chewing diet, which is essential for several weeks after the surgery. If bone grafting in not scheduled, the R.D. assesses the usual dietary intake and growth pattern and makes recommendations for improvement. Educational materials presented to families during the first clinic visit following birth and for bone graft surgery will be available for review. Funding Disclosure: None
The Nutrition, Feeding and Swallowing Program Author(s): H. L. Weiss,1 K. Lovely,1 J. Mikami2; 1Nutrition, Feeding, and Swallowing Program, Child Health Services, Manchester, NH, 2 Nutrition, Feeding, and Swallowing Program, SERESC, Bedford, NH Learning Outcome: To explore alternative options for serving children and youth with special health care needs. The Nutrition, Feeding and Swallowing Program recognize the unique requirements of children with special health care needs in the community. Our agency has a team of dietitians and feeding & swallowing providers who make home visits throughout the state of New Hampshire. The providers, referred to as the Nutrition, Feeding and Swallowing Program, are employed by a collaborative agency between Child Health Services, SERESC and the State of New Hampshire. They typically conduct 1-4 nutrition and/or feeding & swallowing evaluations and follow ups annually per client. A dietitians and/or a feeding & swallowing provider join parents, physicians and other community service providers to create a coordinated feeding team for each child. The benefits of home based nutrition care center include observations that a trained nutritionist can make during mealtime at home in a more relaxed setting than during office visits. Recommendations can be tailored to the unique family environment taking into account family dynamics (child/sibling, parent/child interactions), meal schedules, and family meal culture. There is also a unique opportunity to reinforce recommendations made during mealtime. This defined nutritional intervention can ease the sense of being overwhelmed by information which families can experience at a regular office/clinic visit. If the patient does not have medical insurance that covers these services, the Nutrition, Feeding, and Swallowing Program will cover these services for them, regardless of income. We believe home nutrition visits should be explored as an option to enhance current approaches to serving children with special health care needs. Funding Disclosure: None
A-36 / September 2010 Suppl 2—Abstracts Volume 110 Number 9