Early high-energy feeding in infants following cardiac surgery: a randomized controlled trial

Chen, Xi; Zhang, Mingjie; Song, Yining; Luo, Yang; Wang, Liping; Xu, Zhiwei; Bao, Nan

doi:10.21037/tp-21-360

Cited by 10 publications

(7 citation statements)

References 34 publications

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“…Among two studies, reported median and interquartile range (IQR). 21 , 22 We manually calculated mean and standard deviation for these two studies using mean (SD) conversion formula. Dichotomous variables considered secondary outcomes and analyzed using RR formula.…”

Section: Resultsmentioning

confidence: 99%

“…Secondary outcomes reported six studies namely post-surgery infections (n=574) (RR=0.68, 95% CI: 0.43 to 1.08, P =0.40, I 2 =3%), 18 , 20 , 22 , 23 , 25 , 26 three studies reported vomiting (n=163) (RR=1.47, 95% CI: 0.80 to 2.69, P =0.90, I 2 =0%) 19 , 23 , 25 and three studies reported the mortality (n=218) [RR=0.42, 95% CI: 0.03 to 5.82, P <0.001, I 2 =80], 17 , 19 , 20 which was addressed by subgroup analysis of overall incidence of surgical complications [RR=0.88, 95% CI: 0.58 to 1.36, P 0.08, I 2 = 39], subgroup analysis stated [χ 2 =4.22, df=2, P =0.12] ( Figure 7 ).…”

Section: Resultsmentioning

confidence: 99%

“…Intervention group received enriched energy (EE) or high calories or supplementary nutrition 16 - 21 and Human Milk Fortifier (HMF). 22 , 23 Every two to three hours, a calculated postoperative protein energy feed was administered. 24 - 26 On the other hand, control group received the nutrient as per agency protocol ( Table 1 ).…”

Section: Methodsmentioning

confidence: 99%

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The Impact of Early Enteral Nutrition on Post-operative Hospital Stay and Complications in Infants Undergoing Congenital Cardiac Surgery: A Systematic Review and Meta-analysis

et al. 2022

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Introduction: The congenital cardiac diseases (CHDs) are the leading cause of death in children. The CHDs detection and management have greatly improved over the past few decades. This review aimed to assess the effectiveness of early enteral nutrition (EEN) on postoperative outcomes in infants undergoing congenital cardiac surgery. Methods: Electronic databases PubMed, Clinical Key, UpToDate, the Cochrane Library, and Google Scholar were searched for studies published in the English language, between 2004 and 2021. This review carried out based on PRISMA statement and studies qualities assessed using "Downs and Black score". Hospital stay, intensive care unit (ICU) stay, mechanical ventilation support, aortic cross clamping and cardiopulmonary bypass were as primary outcomes. Similarly infections, vomiting and mortality were as secondary outcomes of included studies. Results: This review consists of 887 infants from 10 studies. Of these, 470 infants were assigned to the intervention group and 417 to the control group. The post-operative hospital stay shorted in the EEN group than the control group (SMD=-0.63, 95% CI: -1.03 to -0.22, P=0.0, I2=87%). Similarly, EEN group lessen the ICU stay (SMD=-0.15, 95% CI: -0.42, 0.11, P=0.0, I2=71%), mechanical ventilation support (SMD=-0.31, 95% CI: -0.51, -08, P=0.08, I2=47%), aortic cross clamping (SMD=-0.92, 95% CI: -0.31, 2.4, P=0.00, I2=96%), and cardiopulmonary bypass (SMD=-0.0, 95% CI: -0.42 to 43, P=0.00, I2=71%). Secondary postoperative complications such as infections (RR=0.68, 95% CI: 0.43 to 1.08, P=0.40, I2=3%). vomiting (RR=1.47, 95% CI: 0.80 to 2.69, P=0.90, I2=0%) and postoperative mortality (RR=0.42, 95% CI: 0.03 to 5.82, P=0.00: I2=80%) significantly reduced. Conclusion: Postoperative outcomes were improved in the intervention group compared to the control group, including shorter hospital stays, ICU stays, mechanical ventilation, and less postoperative complications.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The Impact of Early Enteral Nutrition on Post-operative Hospital Stay and Complications in Infants Undergoing Congenital Cardiac Surgery: A Systematic Review and Meta-analysis

et al. 2022

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“…In addition, while conservative feeding practices are beneficial in reducing intolerance, they may, on the other hand, further reduce nutritional intake. Therefore, faced with the conflict between fluid restriction and insufficient intake, high energy formula can provide patients with more nutrition [ 24 , 25 ]. It is also possible to take a cue from another study and add pure whey protein isolate to formula [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

What is the postoperative nutrition intake in children with congenital heart disease? A single-center analysis in China

Zhang

et al. 2022

BMC Pediatr

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Background It is common that inadequate nutritional intake happens in patients with congenital heart disease (CHD), which can adversely affect the prognosis of patients. However, the details and reasons are not clear enough so far. Therefore, the primary aim of this study was to investigate the current nutritional requirements and energy intake on days 1–7 in the cardiac intensive care unit after surgery. Our secondary aim was to investigate potential factors that hinder nutritional supply and to compare the resting energy expenditure (REE) based on two methods, the Fick method and the Schofield equation. Methods Using retrospective analysis, we collected data from postoperative children with CHD at a children's hospital in Shanghai, China. We used the Fick method to calculate the REE, and compare the results with the actual enteral nutrition intake. Meanwhile, we recorded the initiation time of enteral nutrition, feeding intolerance, unfinished milk volume, etc. Then the correlation between the results of the Fick method and the equation method was calculated. Results A total of 49 patients were included, with a median age of 22 months (IQR 4.9, 57.3), and a median Aristotle basic complexity score of 8 (IQR 6.0, 9.8). The time interval for surgical intervention within 7 days after operation was 4 (IQR 2.5, 6). No statistical difference in REE on postoperative days 1–7. The average enteral nutrition energy provided 64.6 (33.6, 79.6)% of the REE, which showed a significant decrease on postoperative day 4, and then reached its lowest on postoperative day 5. The protein supply was 0.7 ± 0.3 kcal/kg/d. In addition, the REE calculated by the Fick method was moderately correlated with that estimated by the equation (r = 0.467, P = 0.001). Conclusions The energy and protein supply in the acute postoperative period in children with CHD is inadequate. Fluid restriction and fasting may be the main causes. In addition, there is a moderate correlation between the REE calculated by the Fick method and that estimated by the equation.

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“…Nutritional rehabilitation forms one of the cornerstones of critical care management of infants undergoing congenital heart surgery (CHS). [1][2][3] Malnutrition is common in infants with congenital heart disease (CHD) due to increased metabolic demands arising from the specific pathophysiology and decreased energy supply due to poor feeding abilities coupled with malabsorption. [4][5][6] In the perioperative period, this supply-demand mismatch is compounded by the effects of stress response to surgery, cardiopulmonary bypass (CPB), inotrope use, fluid restriction and delayed feeding.…”

Section: Introductionmentioning

confidence: 99%

Impact of Type of Enteral Feeds on Early Postoperative Outcomes After Congenital Heart Surgery in Neonates and Young Infants: A Single Center Experience in a Limited Resource Environment

Ghosh

Balachandran

Neema

et al. 2023

World J Pediatr Congenit Heart Surg

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Background: Breast milk is known to prevent infections and is recommended for enteral feeding of infants after congenital heart surgery (CHS). During the Covid-19 pandemic, expressed breast milk (EBM) was not always available; hence, feeding after CHS was maintained with EBM or infant formula (IF) or both; we evaluated the impact of enteral feed type on early postoperative outcomes after CHS. Methods: In a prospective observational study, consecutive neonates and infants <4 months undergoing CHS were divided into EBM, IF, or EBM+IF groups; incidences of postoperative infections, ventilation duration, intensive care unit (ICU) stay, and mortality were studied. Results: Among 270 patients; 90 (33.3%) received EBM, 89 (32.9%) received IF, and 91 (33.7%) received EBM+IF. IF group had more neonates (78.7%[IF] vs 42.2%[EBM] and 52.7%[EBM+IF], P < 0.001) and greater surgical complexity. Postoperative infections were 9 (10.0%) in EBM; 23 (25.8%) in IF; and 14 (15.4%) in EBM+IF ( P = .016). IF group (OR 2.58 [1.05-6.38], P = .040), absence of preoperative feeding (OR 6.97 [1.06-45.97], P = .040), and increase in cardiopulmonary bypass time (OR 1.005 [1.001-1.010], P = .027) were associated with postoperative infection. Ventilation duration in hours was 26 (18-47.5) in EBM; 47 (28-54.5) in IF; and 40 (17.5-67) in EBM+IF ( P = .004). ICU stay in days was 4 (3-7) in EBM; 6 (5-9) in IF; and 5 (3-9) in EBM+IF ( P = .001). Mortality did not differ ( P = .556). Conclusion: IF group had a greater proportion of neonates with higher surgical complexity. Patients who received EBM after CHS had fewer postoperative infections and better postoperative outcomes compared to those receiving IF or EBM+IF.

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Early high-energy feeding in infants following cardiac surgery: a randomized controlled trial

Cited by 10 publications

References 34 publications

The Impact of Early Enteral Nutrition on Post-operative Hospital Stay and Complications in Infants Undergoing Congenital Cardiac Surgery: A Systematic Review and Meta-analysis

The Impact of Early Enteral Nutrition on Post-operative Hospital Stay and Complications in Infants Undergoing Congenital Cardiac Surgery: A Systematic Review and Meta-analysis

What is the postoperative nutrition intake in children with congenital heart disease? A single-center analysis in China

Impact of Type of Enteral Feeds on Early Postoperative Outcomes After Congenital Heart Surgery in Neonates and Young Infants: A Single Center Experience in a Limited Resource Environment

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