Abstract
Optimal nutrition is essential to improve short- and long-term outcomes in newborns with congenital heart disease (CHD). Nevertheless, several issues on nutritional management and concerns about the potential risk of complications related to enteral feeding exist. This narrative review aims to summarize and discuss the available literature on enteral feeding in term infants with CHD. A wide variability in feeding management exists worldwide. Emerging approaches to improve nutritional status and outcomes in infants with CHD include: implementation of a standardized enteral feeding protocol, both preoperative and postoperative, clearly defining time of initiation and advancement of enteral feeds, reasons to withhold, and definitions of feeding intolerance; early minimal enteral feeding; enteral feeding in stable term infants on hemodynamic support; evaluation of enteral feeding in term infants with umbilical arterial catheters and during prostaglandin infusion; assessment and support of oro-motor skills; and promotion and support of breastfeeding and provision of mother’s own milk or donor milk when mother’s own milk is not available. As evidence from term infants is scarce, available observations and recommendations partially rely on studies in preterm infants. Thus, well-designed studies assessing standardized clinically relevant outcomes are needed to provide robust evidence and shared recommendations and practices.
Highlights
Congenital heart disease (CHD) is one of the most common anomalies of human development, with an estimated incidence of 4 to 10 cases per 1000 live births and of about6 per 1000 live births for moderate and severe forms [1,2,3]
Preoperative feeding practices in infants with CHD are very heterogeneous across Intensive Care Units (ICUs) worldwide, and a shared feeding strategy defining the timing for feeding introduction, feeding modality, or optimal intakes is lacking [16,17]
necrotizing enterocolitis (NEC) is a rare condition in term newborns without CHD; the disease is at least 10–100 times more common in CHD infants [33], with an estimated incidence ranging from 1.6% to 9% [24,33,55,56,57] and mortality rates between 6.8% and 24% [24,55]
Summary
Congenital heart disease (CHD) is one of the most common anomalies of human development, with an estimated incidence of 4 to 10 cases per 1000 live births and of about. Most infants born with CHD have a normal weight for gestational age at birth [4], but a relevant proportion of them (between 15% and 41%) [5,6] develop malnutrition and growth deficiencies during the first months of life, this leading to delayed or complicated cardiac surgery [5,7]. A high risk of growth failure persists in the postoperative period [11]; while successful surgical treatment of CHD improves neonates’ long-term survival, catch-up growth is impaired in a relevant proportion of these infants [12]. The consequences of malnutrition during critical illness and perioperatively can be more severe in young children and neonates, since in this population greater caloric and nutrients intakes are required to promote an adequate growth and psychomotor development [13]. The aim of this narrative review is to summarize currently available literature on enteral feeding in term infants with CHD, to highlight open issues, and to identify future directions for the improvement of clinical practice
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