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

Xi Chen, Mingjie Zhang, Yixiao Song, Yiwen Luo, Liping Wang, Zhuoming Xu, Nan Bao, Xi Chen, Mingjie Zhang, Yixiao Song, Yiwen Luo, Liping Wang, Zhuoming Xu, Nan Bao

Abstract

Background: Effective nutrition programs are beneficial for nutritional recovery in infants. Few studies have focused on the effect of early high-energy feeding after open heart surgery. This study sought to assess the effects of early high-energy feeding in infants after congenital heart surgery.

Methods: Patients at a tertiary pediatric cardiology center who underwent open heart surgery between July 2016 and July 2018 were recruited and randomly allocated to 1 of the following 2 groups: (I) the intervention group (postoperative early high-energy feeding; n=124); and (II) the control group (no intervention; n=120).The primary endpoints of average energy delivery and growth Z-scores [i.e., weight-for-height Z-score (WHZ), weight-for-age Z-score (WAZ), and height-for-age Z-score (HAZ)] were recorded preoperatively, during the intensive care unit (ICU) stay, at discharge, and at 1 and 3 months postoperatively. The secondary endpoints of malnutrition recovery, ventilator support time, infection rate, and cardiac ICU (CICU) stay were also recorded.

Results: A total of 244 infants were included in the study. There were no significant differences in the baseline features between the 2 groups. The intervention group received higher calories on average than the control group (44.5 vs. 34.7; P<0.001). At discharge from the ICU, the WHZ (-2.29 vs. -2.76; P<0.001) and WAZ (-3.08 vs. -3.43; P=0.005) of patients in the intervention group were higher than those of patients in the control group. Ventilator support time (P=0.004), CICU stay (P=0.045), and infection rate (P=0.001) were significantly lower in the intervention group than the control group. At 3 months post-surgery, the intervention group exhibited a higher malnutrition recovery rate than the control group (19.4% vs. 6.5%; P=0.002).

Conclusions: The administration of early high-energy feeding to infants after congenital heart surgery is associated with improved growth, reduced CICU stay, decreased ventilator support time, and reduced postoperative infection rates.

Trial registration: ClinicalTrials NCT04609358.

Keywords: Congenital heart disease; high-energy nutrition; malnutrition; randomized controlled trial.

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/tp-21-360). All authors report that this work was supported by the Key Subject Program for Clinical Nutrition from Shanghai Municipal Health Commission for Li HONG [No. 2019ZB0103]. The authors have no other conflicts of interest to declare.

2021 Translational Pediatrics. All rights reserved.

Figures

Figure 1
Figure 1
Flowchart for patient screening, randomization, and follow-up.

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