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Despite 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 methods
The 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.
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.
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.
Near ice shelves around Antarctica the ocean becomes supercooled and has been observed to carry small suspended ice crystals. Our measurements demonstrate that these small crystals are persistently present in the water column beneath the winter fast ice, and when incorporated in sea ice they reduce the mean grain size of the sea-ice cover. By midwinter, larger ice crystals below the ice/water interface are observed to form a porous sub-ice platelet layer with an ice volume fraction of 0.25 ± 0.06. The magnitude and direction of the oceanic heat flux varied between (5 ± 6) Wm-2 (upwards) and (-15 ± 10) Wm-2 (downwards) in May, but by September it settled between (-6 ± 2) and (-11 ± 2) W m-2. The negative values imply that the ocean acts as a heat sink which is responsible for the growth of 12% of the ice thickness between June and September. This oceanic contribution should not be ignored in models of Antarctic sea-ice thickness close to an ice shelf.