Department of Pediatrics, Wayne State University School of Medicine, Detroit, Mich, USA. gnatara @ med.wayne.edu
Neonatology. 2010;98(4):330-6. doi: 10.1159/000285706. Epub 2010 May 7.
Despite their putative impact on post-operative outcomes, there is paucity of data on enteral feeding practices of neonates with congenital heart disease (CHD).
To examine feeding patterns among neonates with CHD before and after surgical repair and determine the incidence of and to identify risk factors associated with feeding-related morbidities.
Retrospective data review of neonates with CHD who underwent surgical repair within the first month of life. SPSS software (version 17) was used for analyses and p < 0.05 taken as significant.
The median (range) gestational age of our cohort (n = 67) was 39 weeks (32-41) and birth weight 3,100 g (1,615-4,280). Ductal-dependent lesions were diagnosed in 52 infants (77.6%). Prior to surgery, feedings were initiated in 62 infants (92.5%) at a median age of 2.5 days (1-18); 100 ml/kg daily intake was achieved in 47 infants (70.1%) at 5 days (1-20) and full feeds in 22 infants (32.8%). Postoperative enteral feeds were started 3 days (1-20) after surgery in 66 infants (98.5%) and intake of 100 ml/kg/day was reached in 64 infants at 5 postoperative days (1-29). Four infants (5.9%) died; 27 (40.3%) were on at least partial gavage feedings at the time of discharge home. NEC was diagnosed in 2 infants. On regression analysis, cardiopulmonary bypass (p = 0.024) and age at which full feeds were attained prior to surgery (p = 0.039) were significantly associated with death and/or gavage at discharge.
The majority of infants with CHD achieve moderate enteral intake prior to surgery, even while on prostaglandins. Despite this and the early initiation of postoperative enteral feeds, many infants need gavage feeds at discharge. Evidence-based feeding strategies for this high-risk population are critical to improving outcomes.
尽管肠内喂养对先天性心脏病（CHD）患儿术后结局有潜在影响，但目前关于此类患儿喂养方式的数据仍较少。
探讨 CHD 患儿手术修复前后的喂养模式，并确定与喂养相关并发症相关的发病率和危险因素。
对出生后 1 个月内接受手术修复的 CHD 新生儿进行回顾性数据分析。采用 SPSS 软件（版本 17）进行分析，p<0.05 为差异有统计学意义。
本队列（n=67）的中位（范围）胎龄为 39 周（32-41），出生体重为 3100g（1615-4280）。52 例（77.6%）患儿诊断为依赖动脉导管的病变。62 例（92.5%）患儿在中位数为 2.5 天（1-18）时开始喂养，100ml/kg 每日摄入量在 47 例（70.1%）患儿中于第 5 天（1-20）达到，22 例（32.8%）患儿达到全量喂养。66 例（98.5%）患儿在术后 3 天（1-20）开始肠内喂养，64 例（95.5%）患儿在术后第 5 天（1-29）达到 100ml/kg/天的摄入量。4 例（5.9%）患儿死亡，27 例（40.3%）患儿出院时仍存在部分管饲喂养。2 例（2.9%）患儿诊断为坏死性小肠结肠炎。回归分析显示，体外循环（p=0.024）和术前达到全量喂养的年龄（p=0.039）与死亡和/或出院时需要管饲喂养显著相关。
尽管 CHD 患儿在接受手术前需要应用前列腺素，但大多数患儿可实现中等程度的肠内喂养。尽管如此，且术后早期开始肠内喂养，许多患儿在出院时仍需要管饲喂养。为这一高危人群制定基于循证的喂养策略对改善结局至关重要。
