Early enteral nutrition therapy in congenital cardiac repair postoperatively: A randomized, controlled pilot study

Abstract

Background and Objectives:Adequate nutritional supplementation in infants with cardiac malformations after surgical repair is a challenge. Critically ill infants in the early postoperative period are in a catabolic stress. The mismatch between estimated energy requirement (EER) and the intake in the postoperative period is multifactorial, predisposing them to complications such as immune deficiency, more infection, and growth failure. This study aimed to assess the feasibility and efficacy of enriched breast milk feed on postoperative recovery and growth of infants after open heart surgery.Methodology:Fifty infants <6 months of age were prospectively randomized in the trial for enteral nutrition (EN) postoperatively from day 1 to 10, after obtaining the Institute Ethics Committee's approval. They were equally divided into two groups on the basis of the feed they received: Control group was fed with expressed breast milk (EBM; 0.65 kcal/ml) and intervention group was fed with EBM + energy supplementation/fortification with human milk fortifier (7.5 kcal/2 g)/Simyl medium-chain triglyceride oil (7.8 kcal/ml). Energy need for each infant was calculated as per EER at 90 kcal/kg/day, as the target requirement. The intra- and post-operative variables such as cardiopulmonary bypass and aortic cross-clamp times, ventilation duration, Intensive Care Unit (ICU), and hospital length of stay and mortality were recorded. Anthropometric and hematological parameters and infection control data were recorded in a predesigned pro forma. Data were analyzed using Stata 14.1 software.Results:The duration of mechanical ventilation, length of ICU stay (LOIS), length of hospital stay (LOHS), infection rate, and mortality rate were lower in the intervention group compared to the control group although none of the differences were statistically significant. Infants in control group needed mechanical ventilation for about a day more (i.e., 153.6 ± 149.0 h vs. 123.2 ± 107.0 h; P = 0.20) than those in the intervention group. Similarly, infants in control group stayed for longer duration in the ICU (13.2 ± 8.9 days) and hospital (16.5 ± 9.8 days) as compared to the intervention group (11.0 ± 6.1 days; 14.1 ± 7.0 days) (P = 0.14 and 0.17, respectively). The LOIS and LOHS were decreased by 2.2 and 2.4 days, respectively, in the intervention group compared to control group. The infection rate (3/25; 5/25) and mortality rate (1/25; 2/25) were lower in the intervention group than those in the control group. The energy intake in the intervention group was 40 kcal more (i.e., 127.2 ± 56.1 kcal vs. 87.1 ± 38.3 kcal) than the control group on the 10th postoperative day.Conclusions:Early enteral/oral feeding after cardiac surgery is feasible and recommended. In addition, enriching the EBM is helpful in achieving the maximum possible calorie intake in the postoperative period. EN therapy might help in providing adequate nutrition, and it decreases ventilation duration, infection rate, LOIS, LOHS, and mortality.

Tolerability and Effects of the Use of Energy‐Enriched Infant Formula After Congenital Heart Surgery: A Randomized Controlled Trial

“…Although previous studies have demonstrated that infants tolerate higher amounts of macronutrients after surgery well, there is still insecurity in feeding these patients because of their clinical severity. This study may contribute to demonstrating that patients tolerate well EE formula after surgery, and the benefits may be seen early after intervention.…”

“…The mentioned study has also observed a reduction in HLOS, as was observed in this study. Similarly, another randomized study evaluated the use of human milk fortifier and described a trend in reduction in length of MV, ICULOS, and HLOS. A case control study evaluated the implementation of a feeding protocol for the initiation and advancement of enteral feeding in children with CHD and observed a reduction in HLOS after the implementation.…”

Postoperative feeding problems in patients with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals undergoing unifocalisation surgery

“…There is ample evidence that postoperative feeding via an enteric tube is effective in its ability to provide adequate nutrition for recovery in patients with complex CHD, and Newcombe et al have shown that using a standard postoperative nutritional pathway has led to improved outcomes. [23][24][25] Limitations This study is limited by its retrospective design; therefore, we can only identify associations with our outcome and are unable to establish a cause and effect. Our goal was to understand possible risk factors for feeding tube use at time of discharge to allow for early institution of feeding tubes in high-risk populations to reduce hospital length of stay.…”

Major Predictors of Incidence of Congestive Heart Failure and the Responsive Character of Enteral Nutrition: Meta-Analysis

“…Congestive heart failure (CHF) is a serious and growing public health problem worldwide, being the final common pathway of most heart diseases [ 1 , 2 ]. Although the scientific and technological advances and the better socioeconomic conditions have allowed the increase of the longevity of the general population and of the cardiac patients, there has been an increase in the incidence of CHF in the world [ 2 - 4 ]. Approximately 23 million people are carriers of this disease and two million new cases are diagnosed each year.…”

“…Approximately 23 million people are carriers of this disease and two million new cases are diagnosed each year. CHF is an important public health issue due to its high prevalence, severity of clinical manifestations and reserved prognosis [ 3 , 4 ].…”