Preoperative Feeding Neonates With Cardiac Disease

Abstract

Background The potential for necrotizing enterocolitis (NEC) in neonates undergoing cardiac surgery has contributed largely to wide feeding practice variations and a hesitation to initiate enteral feeding during the preoperative period, specifically those patients with hypoplastic left heart syndrome. Methods A retrospective chart review of neonates undergoing cardiac surgery at a single institution between July 2011 and July 2013 was performed. The primary objective of this study was to determine if preoperative feeding was associated with necrotizing enterocolitis (NEC) in neonates requiring cardiac surgery. Univariable and multivariable analyses were performed to evaluate the relationship between preoperative feeding and NEC. Secondary outcomes including growth failure, total ventilator days and total length of stay were analyzed. Results One hundred thirty consecutive neonates who required cardiac surgery were included in the analysis. Preoperative feeding occurred in 61% (n=79). The overall prevalence of NEC was 9% (12/130), including 3 neonates with surgical NEC. There was no difference in the prevalence of NEC between the preoperative feeding and nil per os (NPO) groups. NPO preoperatively was associated with longer ventilator dependent days (p=0.01) but was not associated with worsened growth failure or longer length of stay. Conclusion In this study cohort, preoperative feeding was not associated with NEC. Larger prospective studies evaluating the safety and benefits of preoperative feeding in cardiac neonates are warranted.

Suspected necrotising enterocolitis after surgery for CHD: an opportunity to improve practice and outcomes

“…However, the incidence of confirmed or advanced necrotising enterocolitis in our cohort was similar at 6%. 4,11,12 Similar to prior studies, we found that single-ventricle physiology, lower weight, and younger age were risk factors for both suspected and confirmed necrotising enterocolitis. 6 Among our neonatal single-ventricle patients, the incidence of confirmed or advanced necrotising enterocolitis was 14%, similar to the 17-18% reported in the literature.…”

“…Previous published reports of necrotising enterocolitis in comparable populations demonstrated an incidence of 3.3-9%. 4,11,12 These previous studies were largely focused on confirmed or advanced disease. We speculate that they underestimate the incidence of suspected necrotising enterocolitis.…”

Evaluating the Impact of a Feeding Protocol in Neonates before and after Biventricular Cardiac Surgery

“…There has historically been hesitation to feed these patients before surgery secondary to the concern for the risk of development of NEC. 14 This risk of NEC is higher among single ventricle physiology patients. 15 – 17 On the contrary, other studies have shown preoperative enteral feeding can be associated with decreased risk of prolonged feeding difficulties postoperatively in some populations and 18 delaying enteral feeding may contribute to increased gut abnormalities and even delayed postnatal intestinal development, maturation, and motility problems.…”

“…Prior literature supports that adherence to a feeding protocol may promote earlier enteral feeding and shorter time to reach full calories and decrease the use of TPN and central lines. 5 , 6 Studies have also shown patients receiving TPN have an increased risk of a central line–associated blood stram infections (CLABSI) and a reduction of time on TPN is beneficial to patients. 7 Adherence to a feeding protocol may decrease these risks and improve quality of care by reducing practice variation among providers.. 1 , 4 , 8 , 9 …”

The features of nutritional status in children with congenital heart disease

“…Позднее начало энтерального кормления может привести к атрофическим изменениям стенок кишечника, их патологической проницаемости, в дальнейшемк замедлению процессов развития и созревания кишечника, нарушению моторики. Раннее начало энтерального кормления рассматривается как важная часть оптимизации периоперационного периода, способствующая постнатальному созреванию интерстинального барьера, развитию клеток и слизистой оболочки, формированию здоровой кишечной микробиоты [22,25].…”