Scahill Carly J, Graham Eric M, Atz Andrew M, Bradley Scott M, Kavarana Minoo N, Zyblewski Sinai C
1 Department of Pediatrics, The Heart Institute, Children's Hospital Colorado, Aurora, CO, USA.
2 Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
World J Pediatr Congenit Heart Surg. 2017 Jan;8(1):62-68. doi: 10.1177/2150135116668833.
The potential for necrotizing enterocolitis (NEC) in neonates requiring cardiac surgery has contributed largely to wide feeding practice variations and a hesitation to initiate enteral feeding during the preoperative period, specifically those patients with hypoplastic left heart syndrome.
A retrospective chart review of neonates undergoing cardiac surgery at a single institution between July 2011 and July 2013 was performed. The primary objective of this study was to determine if preoperative feeding was associated with NEC in neonates requiring cardiac surgery. Univariable and multivariable analyses were performed to evaluate the relationship between preoperative feeding and NEC. Secondary outcomes including growth failure, total ventilator days, total length of stay, and tube-assisted feeds at discharge were analyzed.
One hundred thirty consecutive neonates who required cardiac surgery were included in the analysis. Preoperative feeding occurred in 61% (n = 79). The overall prevalence of NEC was 9% (12/130), including three neonates with surgical NEC. There was no difference in the prevalence of NEC between the preoperative feeding and nil per os (NPO) groups. Preoperative NPO status was associated with longer ventilator-dependent days ( P = .01) but was not associated with worsened growth failure, longer length of stay, or increased prevalence of tube-assisted feeds at discharge.
In this study cohort, preoperative feeding was associated with a low prevalence of NEC. Larger prospective studies evaluating the safety and benefits of preoperative feeding in cardiac neonates are warranted.
需要心脏手术的新生儿发生坏死性小肠结肠炎（NEC）的可能性在很大程度上导致了喂养实践的广泛差异以及术前尤其是患有左心发育不全综合征的患者在开始肠内喂养时的犹豫。
对2011年7月至2013年7月在单一机构接受心脏手术的新生儿进行回顾性病历审查。本研究的主要目的是确定术前喂养是否与需要心脏手术的新生儿的NEC相关。进行单变量和多变量分析以评估术前喂养与NEC之间的关系。分析了包括生长发育不良、总机械通气天数、总住院时间和出院时管饲喂养在内的次要结局。
130例连续需要心脏手术的新生儿纳入分析。61%（n = 79）的患儿进行了术前喂养。NEC的总体患病率为9%（12/130），包括3例手术性NEC患儿。术前喂养组和禁食（NPO）组的NEC患病率无差异。术前NPO状态与机械通气依赖天数延长相关（P = 0.01），但与生长发育不良加重、住院时间延长或出院时管饲喂养患病率增加无关。
在本研究队列中，术前喂养与NEC的低患病率相关。有必要进行更大规模的前瞻性研究来评估心脏手术新生儿术前喂养的安全性和益处。
