Effects and Tolerance of Protein and Energy‐Enriched Formula in Infants Following Congenital Heart Surgery: A Randomized Controlled Trial

Congenital heart disease (CHD) is 1 of the most common congenital malformations, and considerable numbers of infants and young children with CHD undergo cardiopulmonary bypass surgery. It has been increasingly realized that perioperative nutrition support plays an important role in improving clinical outcomes. The purpose of this review, by searching PubMed, was to examine the nutrition conditions in perioperative children with CHD and the main problems in nutrition management in the cardiac intensive care unit (CICU), based on which future directions were proposed. We found that preoperative poor nutrition status is common. This limited reserve of energy and protein is further compounded by the complex metabolic alterations with hypermetabolism, hypercatabolism, and hypoanabolism in the early postoperative course. Knowledge about energy and protein metabolism and requirements in children after cardiopulmonary bypass remains very limited. The current nutrition recommendations in the CICU are based on little evidence. Insufficient energy and protein supply to meet demands remains a norm in the immediate postoperative period. The commonly used predictive equations do not provide accurate estimate of energy requirement in individual patients during the highly dynamic postoperative course. Indirect calorimetry can provide the best estimate of energy requirements for children with CHD in the CICU. Measurement of nitrogen balance is the recommended method to determine the minimal protein requirement. During the early postoperative period, daily measurements of resting energy expenditure using indirect calorimetry and nitrogen balance in each individual child are essential to optimize energy and protein supply to meet requirements.

Energy and Protein Requirements in Children Undergoing Cardiopulmonary Bypass Surgery: Current Problems and Future Direction

Zhang

Cui

et al. 2018

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

Scheeffer

Ricachinevsky

Freitas

et al. 2019

Background Undernutrition is a common problem among children with congenital heart disease (CHD) and may lead to poorer surgical outcomes. A higher intake of energy during the postoperative period of CHD surgery seems to be associated with better outcomes. This study aimed to investigate the effect of the use of energy‐enriched formula (EE‐formula) compared with normocaloric formula during 30 days after CHD surgery. Methods A randomized controlled trial with patients undergoing heart surgery in a tertiary hospital in southern Brazil from March 2017 to December 2017 was performed. The intervention group received EE‐formula (1 kcal/mL), and the control group received normocaloric formula (0.67 kcal/mL). The researcher in charge of anthropometric evaluation was blinded to the randomization. Results Fifty‐nine patients were included; 30 in control group and 29 in intervention group. There were no statistically significant differences between groups regarding age, gender, anthropometry, and surgical risk classification after randomization. A statistically significant difference in z‐score of weight for age and in weight gain variation rate between groups after intervention was observed. Antibiotic use was less frequent in the intervention group, and hospital length of stay was shorter. General gastrointestinal side effects were similar between groups, whereas diarrhea was more frequent in the intervention group. However, this side effect was limited and had spontaneous resolution in 4 out of 6 cases. Conclusion This study demonstrates that EE‐formula use after heart surgery of patients with CHD is well tolerated and may improve short‐term nutrition outcome, decrease hospital stay, and reduce antibiotic use.

Early Growth Trajectory of Infants With Simple Congenital Heart Disease and Complex Congenital Heart Disease Undergoing Cardiac Repair: A Prospective Cohort Study in China

Shi

Zhang

et al. 2020

Background We aimed to evaluate the growth trajectory of infants with congenital heart disease (CHD) and to analyze the effects of disease classification on their growth trajectory. Methods A prospective cohort of infants with CHD was enrolled and divided into 2 groups: simple CHD (SC) and complex CHD (CC) groups. All patients were followed up for 6 months after CHD surgery. Weight for age (WAZ), length for age (LAZ), weight for length (WLZ), and head circumference for age were compared between the 2 groups using mixed‐effects linear regression. Result Between September 2018 and November 2019, 801 patients had data collected. The z‐score trend decreased (e.g., ΔWAZ: 1.29±1.44) and then increased (e.g., ΔWAZ: 1.06±1.13), and all z‐scores were below 0 from birth to 6 months postoperatively. Mixed‐effects linear regression models indicated that the postoperative WAZ and WLZ scores of the CC group were lower than those of the SC group after adjustment (WAZ: β = −0.72; 95% confidence interval [CI], −1.37 to −0.07; P = .03) (WLZ: β = −0.93, 95% CI, −1.67 to −0.19; P = .01). The models also showed an interaction effect between disease classification and preoperative growth status on infant growth outcome (WAZ: interaction β = −0.48; 95% CI, −0.88 to −0.07; P = .02) (WLZ: interaction β = −0.36; 95% CI, −0.60 to −0.12; P = .004) (LAZ: interaction β = −0.29; 95% CI, −0.56 to −0.02; P = .04). Conclusions Compared with SC children, CC children have deficits in their early growth trajectories. The type of disease and preoperative growth status synergistically affect the early postoperative growth trajectory.