Department of Cardiac Anesthesia, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
World J Pediatr Congenit Heart Surg. 2023 May;14(3):300-306. doi: 10.1177/21501351231154207. Epub 2023 Feb 23.
Breast milk is known to prevent infections and is recommended for enteral feeding of infants after congenital heart surgery (CHS). During the Covid-19 pandemic, expressed breast milk (EBM) was not always available; hence, feeding after CHS was maintained with EBM or infant formula (IF) or both; we evaluated the impact of enteral feed type on early postoperative outcomes after CHS. In a prospective observational study, consecutive neonates and infants <4 months undergoing CHS were divided into EBM, IF, or EBM+IF groups; incidences of postoperative infections, ventilation duration, intensive care unit (ICU) stay, and mortality were studied. Among 270 patients; 90 (33.3%) received EBM, 89 (32.9%) received IF, and 91 (33.7%) received EBM+IF. IF group had more neonates (78.7%[IF] vs 42.2%[EBM] and 52.7%[EBM+IF], < 0.001) and greater surgical complexity. Postoperative infections were 9 (10.0%) in EBM; 23 (25.8%) in IF; and 14 (15.4%) in EBM+IF ( = .016). IF group (OR 2.58 [1.05-6.38], = .040), absence of preoperative feeding (OR 6.97 [1.06-45.97], = .040), and increase in cardiopulmonary bypass time (OR 1.005 [1.001-1.010], = .027) were associated with postoperative infection. Ventilation duration in hours was 26 (18-47.5) in EBM; 47 (28-54.5) in IF; and 40 (17.5-67) in EBM+IF ( = .004). ICU stay in days was 4 (3-7) in EBM; 6 (5-9) in IF; and 5 (3-9) in EBM+IF ( = .001). Mortality did not differ ( = .556). IF group had a greater proportion of neonates with higher surgical complexity. Patients who received EBM after CHS had fewer postoperative infections and better postoperative outcomes compared to those receiving IF or EBM+IF.
母乳已知可预防感染，建议在先天性心脏病（CHS）手术后对婴儿进行肠内喂养。在 COVID-19 大流行期间，并非总是能获得母乳，因此，CHS 后通过母乳、婴儿配方奶粉（IF）或两者的组合来维持喂养；我们评估了肠内喂养类型对 CHS 后早期术后结局的影响。在一项前瞻性观察研究中，连续接受 CHS 的新生儿和<4 个月大的婴儿分为母乳、IF 或母乳+IF 组；研究了术后感染、通气时间、重症监护病房（ICU）住院时间和死亡率的发生率。在 270 例患者中；90 例（33.3%）接受母乳，89 例（32.9%）接受 IF，91 例（33.7%）接受母乳+IF。IF 组新生儿比例更高（78.7%[IF]比 42.2%[母乳]和 52.7%[母乳+IF]，<0.001），手术难度更大。母乳组有 9 例（10.0%）感染，IF 组有 23 例（25.8%）感染，母乳+IF 组有 14 例（15.4%）感染（=0.016）。IF 组（OR 2.58[1.05-6.38]，=0.040）、无术前喂养（OR 6.97[1.06-45.97]，=0.040）和体外循环时间增加（OR 1.005[1.001-1.010]，=0.027）与术后感染相关。母乳组通气时间为 26（18-47.5）小时，IF 组为 47（28-54.5）小时，母乳+IF 组为 40（17.5-67）小时（=0.004）。ICU 住院天数为 4（3-7）天，IF 组为 6（5-9）天，母乳+IF 组为 5（3-9）天（=0.001）。死亡率无差异（=0.556）。IF 组新生儿比例较高，手术难度较大。与 IF 或母乳+IF 组相比，CHS 后接受母乳的患者术后感染更少，术后结局更好。
