title: Clinical audit results in earlier nutritional intervention in malnourished children with cystic fibrosis with improved outcome.
abstract: OBJECTIVE
  The association between nutritional status, pulmonary function and survival in cystic fibrosis (CF) is well established. A previous case series from the Royal Children's Hospital, Melbourne (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.
  
  
  METHODS
  Clinical audit of all CF patients who had undergone gastrostomy insertion from 2002 to 2010 at Royal Children's Hospital. 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. Pseudomonas 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.
  
  
  CONCLUSIONS
  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.
authors: Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors: Oren
authors: O
authors: Ledder
authors: Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.|Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
authors: Mark R
authors: MR
authors: Oliver
authors: Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.|Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
authors: Ralf G
authors: RG
authors: Heine
authors: Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors: Joanne
authors: J
authors: Graham
authors: Department of Nutrition & Dietetics, Monash University, Melbourne, Victoria, Australia.
authors: Evelyn
authors: E
authors: Volders
authors: Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.|Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
authors: Philip J
authors: PJ
authors: Robinson
mesh_terms: D001835:Body Weight / Q000502:physiology; D002648:Child; D015362:Child Nutrition Disorders / Q000150:complications / Q000601:surgery*; D002675:Child, Preschool; D054869:Clinical Audit; D003550:Cystic Fibrosis / Q000150:complications / Q000601:surgery*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D009752:Nutritional Status; D015996:Survival Rate; D013997:Time Factors
keywords: gastroenterology; nutrition; respiratory