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

Abstract

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.

High-Energy Enteral Nutrition in Infants After Complex Congenital Heart Surgery

“…Our study did not find a statistical difference in the incidence of diarrhea and fecal occult blood between the two groups, suggesting that critical postoperative infants with CHD can tolerate high-energy nutrition. Two other studies with similar results to the present study have also confirmed that high-energy formula does not increase gastrointestinal adverse effects such as vomiting and diarrhea in patients, nor cardiac, renal and hepatic adverse effects ( 20 , 21 ). Even if the patients in the study by Zhang et al ( 13 ) experienced a small amount of abdominal distention and gastric retention, they could be relieved by gastroprokinetic drugs without affecting the feeding process.…”

Nutritional management in children with disease-related malnutrition : what’s the guideline?

“…Favorable effects were also shown by reduced use of diuretics and oxygen supplementation. 35 Favorable outcomes were also reported by Eveleens et al 34 , who found that critically-ill infants experience weight-for-age (WFA) Z-score following administration of nutrientdense food. These patients achieved the energy target which was determined to be two-fold of the resting energy expenditure.…”

“…Also, the patients had increased serum albumin levels which indicated improvement of nutrition status. 31 Another study by Scheefer et al 35 linked the use of nutrient-dense formula with decreased LOS and use of antibiotics during 30 days after CHD surgery. Favorable effects were also shown by reduced use of diuretics and oxygen supplementation.…”

“…32 Nutrient-dense formula 2. Benefits of using nutrient-dense formula for infants with disease-related malnutrition [31][32][33][34][35][36] exerts more osmotic pressure, leading to increase risk of GI symptoms, such as gastric retention, diarrhea, nausea, and vomiting. However, these symptoms can be easily managed by medication.…”

Nutritional support with energy and nutrient-dense formula for children with congenital heart defects: A clinical trial

“…Preoperative use of high energy formula has been associated with weight gain and decreased hospital stay and postoperative complications (50). Postoperative use of energy-and nutrient-dense formula has been found to improve weight gain in infants with CHD (1) and to decrease hospital stay and reduce antibiotic use in these patients (52). In line with these ndings, we observed a clinically and statistically signi cant weight gain (indicated by an increase in WFA z-score) when energy-and nutrient-dense formula was given preoperatively to malnourished infants with CHD.…”