Mangili Giovanna, Garzoli Elena, Sadou Youcef
Local Health Unit Papa Giovanni XXIII, Bergamo.
Pediatr Med Chir. 2018 May 23;40(1). doi: 10.4081/pmc.2018.196.
Congenital heart disease (CHD) is the most common neonatal congenital malformation. The variety and severity of clinical presentation depend on the cardiac structures involved and their functional impact. The management of newborns with CHD requires a multidisciplinary approach, in which the nutritional aspect plays an important role. An adequate caloric intake during either preand post-surgical period, in fact, improves the outcome of these patients. In addition, the failure to thrive of these children in childhood has been related to long-term cognitive delay (attention deficit disorders, aggressive behaviour and poor social and emotional development). To date, there is a lack of standardized feeding protocols and caloric goals about how to feed neonates with CHD, and current practice varies widely between centres. The latest American Society for Parenteral and Enteral Nutrition guidelines reiterate the importance of proteins, and recommend early start of enteral nutrition, also in the most severe heart diseases, such as univentricular forms. Necrotizing enterocolitis (NEC), the most frequent and feared complication of early feeding of these newborns, often represents an obstacle in spreading this practice. Furthermore, as demonstrated in premature infants, breastfeeding seems to reduce the incidence of NEC. That is why breastfeeding must be encouraged, even if it can be difficult for these mothers due to delivery complications, associated with infant disease. In addition, eating difficulties may persist even after discharge, because these patients require nutritional support through nasogastric tubes or percutaneous endoscopic gastrostomies.
先天性心脏病（CHD）是最常见的新生儿先天性畸形。临床表现的多样性和严重程度取决于受累的心脏结构及其功能影响。患有CHD的新生儿的管理需要多学科方法，其中营养方面起着重要作用。事实上，在手术前后期间摄入足够的热量可改善这些患者的预后。此外，这些儿童在童年期生长发育不良与长期认知延迟（注意力缺陷障碍、攻击性行为以及社交和情感发展不佳）有关。迄今为止，关于如何喂养患有CHD的新生儿，缺乏标准化的喂养方案和热量目标，目前各中心的做法差异很大。美国肠外和肠内营养学会的最新指南重申了蛋白质的重要性，并建议尽早开始肠内营养，即使是在最严重的心脏病，如单心室形式中。坏死性小肠结肠炎（NEC）是这些新生儿早期喂养最常见且令人担忧的并发症，它常常成为推广这种做法的障碍。此外，正如在早产儿中所证明的那样，母乳喂养似乎可降低NEC的发生率。这就是为什么必须鼓励母乳喂养，即使对于这些母亲来说可能因分娩并发症以及婴儿疾病而困难重重。此外，即使出院后进食困难可能仍然存在，因为这些患者需要通过鼻胃管或经皮内镜下胃造口术获得营养支持。
