Background. Cystic fibrosis (CF)-specialized nutrition care strives to meet normal infant growth, but the relationship of dietitian assessments to weight outcomes is unknown. We characterize nutrition management for inadequate weight gain and assess association of dietitian assessments and center-level weight-for-age Z-scores (WAZ).

Methods. We used encounter data from 226 infants across 28 US CF Centers from the Baby Observational Nutritional study between January 2012 through December 2017. We identified dietitian assessments and consensus guideline-recommended responses to inadequate weight gain: calorie increases, pancreatic enzyme replacement therapy (PERT) increases, or shortened time to next visit. We compared center assessments by funnel plot and summarize median WAZ by center.

Results. Of 2,527 visits, 808 (32%) visits had identified inadequate weight gain, distributed in 216 infants. Assessments occurred in 1953 visits (77%), but varied widely between centers (range 17% - 98%). For inadequate weight gain, most and least common responses were calorie increase (64%) and PERT increase (21%). Funnel plot analysis identified 4 high-performers for frequent dietitian assessments (range 92% - 98%) and 4 under-performers (range 17% - 56%). High-performers treated inadequate weight gain more often with adequate calories (24/30, 80% v. 12/23, 52%) and closer follow up (104/164, 63% v. 60/120, 49%) compared to under-performers. Three of 4 high-performing sites met center nutrition goals for positive median WAZ at 2 years old unlike 3 under-performers (WAZ_High 0.33 v. WAZ_Low -0.15), despite similar patient characteristics.

Conclusion: We characterized multicenter variation in dietitian assessments, identifying opportunities to improve care delivery to target early nutrition outcomes.

背景。囊性纤维化 (CF) 专业营养护理致力于满足婴儿的正常生长，但营养师评估与体重结果之间的关系尚不清楚。我们将营养管理描述为体重增加不足，并评估营养师评估与中心级年龄别体重 Z 分数 (WAZ) 之间的关联。

方法。我们使用了 2012 年 1 月至 2017 年 12 月婴儿观察营养研究中来自美国 28 个 CF 中心的 226 名婴儿的遭遇数据。我们确定了营养师评估和共识指南建议的对体重增加不足的反应：卡路里增加、胰酶替代疗法 (PERT)增加或缩短下次访问的时间。我们通过漏斗图比较了中心评估，并按中心总结了 WAZ 中位数。

结果。在 2,527 次就诊中，808 次 (32%) 发现体重增加不足，分布在 216 名婴儿中。评估发生在 1953 次访问 (77%) 中，但中心之间差异很大（范围 17% - 98%）。对于体重增加不足，最常见和最不常见的反应是卡路里增加 (64%) 和 PERT 增加 (21%)。漏斗图分析确定了 4 名经常接受营养师评估的高绩效者（范围 92% - 98%）和 4 名表现不佳的人（范围 17% - 56%）。与其他人相比，表现出色的人更经常通过足够的卡路里（24/30，80% 对 12/23，52%）和更密切的随访（104/164，63% 对 60/120，49%）来治疗体重增加不足表现不佳者。4 个高绩效站点中的 3 个在 2 岁时达到了 WAZ 正中值的中心营养目标，这与 3 个表现不佳的站点不同（WAZ _High 0.33 v. WAZ_低-0.15)，尽管患者特征相似。

结论：我们描述了营养师评估的多中心差异，确定了改善护理服务以针对早期营养结果的机会。