Nutritional programmes improve outcomes in infants with congenital heart disease

In neonates with congenital heart disease, a multi-interventional nutrition programme improves weight gain, discharge outcomes, and enteral feeding without amplifying the risk of necrotizing enterocolitis (NEC), a recent study reports.

Researchers conducted a single-centre cohort analysis of 570 newborns with congenital heart disease who underwent cardiac surgery. The interventions were delivered in two phases. The first involved a feeding algorithm that optimized initiation and progression of parenteral and enteral nutrition, depending on infant postoperative characteristics.

The second phase involved another algorithm that determined the best use of donor breast milk (DBM) in high-risk infants, and included an assessment plan for oromotor skills.

“The programme’s feeding algorithms,” the researchers explained, “were designed to advance feedings differently in patients deemed high-risk versus low-to-average-risk based on their postoperative cardiac physiology.”

The nutrition programme led to fewer gastrostomy tubes (G-tube) at hospital discharge, down to 12 percent after phase 1, from 25 percent at phase 0. Gains were maintained until phase 2, when 14 percent still had G-tubes attached.

Phase 2 of the intervention likewise increased the number of infants who were able to receive enteral nutrition prior to their cardiac surgery, without exacerbating the risk of NEC. The DBM component of phase 2 also led to a higher percentage of patients receiving DBM or expressed breast milk in both preoperative and postoperative periods.

Important study limitations included its retrospective design, which precluded the ability to draw causal links between factors, as well as potentially unmeasured confounders, the researchers said.