Evaluating the Association between Acute Postoperative Enteral Nutrition and Clinical Outcomes in Infants after Congenital Heart Surgery: A Retrospective Cohort Study

Considering the limited evidence for acute postoperative nutritional therapy for congenital heart disease (CHD), this study evaluated the effects of achieving enteral nutrition (EN) targets in the acute postoperative phase on clinical outcomes in infants after congenital heart surgery.

This retrospective cohort study, conducted in a multivalent pediatric intensive care unit (PICU), enrolled infants aged ≤6 months following congenital heart surgery between April 2021 and March 2023. Based on the American Society for Parenteral and Enteral Nutrition guidelines, the EN target was defined as two-thirds of the resting energy expenditure with a protein intake of 1.5 g/kg/day. Clinical outcomes of patients who did and did not achieve the EN target by postoperative day (POD) 7 were compared. The association between EN target achievement and ventilator-free days within 28 days (28-day VFDs) was evaluated.

Of 151 patients who met the inclusion criteria, 97 (64%) who achieved the EN target by POD7 had significantly more 28-day VFDs (median [interquartile range]: 25.0 days [24.0, 26.0] vs. 19.0 days [5.3, 21.8], p < 0.001), a shorter length of stay in the PICU, and a lower nosocomial infection incidence than those who did not. In the multivariate analysis, EN target achievement was independently associated with more 28-day VFDs.

This is the first study to demonstrate an association between achieving a specific EN target during the acute postoperative phase and improved clinical outcomes in infants undergoing congenital heart surgery. These findings underscore the importance of meticulous postoperative nutritional management in this vulnerable population and highlight the need for prospective interventional studies.