Singal Anuradha, Sahu Manoj Kumar, Kumar Geeta Trilok, Aeri Bani Tamber, Manral Mala, Agarwala Anuja, Pandey Shivam
Department of Dietetics, CNC, AIIMS, New Delhi, India.
Department of CTVS, Intensive Care for CTVS, AIIMS, New Delhi, India.
Ann Pediatr Cardiol. 2024 Sep-Oct;17(5):320-330. doi: 10.4103/apc.apc_160_24. Epub 2024 Dec 24.
Congenital heart disease (CHD)-associated malnutrition is a systemic consequence of CHD. Dietary recommendations to fulfill nutritional requirements are lacking. This randomized controlled trial (RCT) was conducted to determine the efficacy of early enteral feeding with supplemented expressed breast milk (suppl-EBM) versus expressed breast milk (EBM) in improving the weight of postoperative cardiac surgical infants.
The primary objective was the weight change between the EBM group and the suppl-EBM group at the 15 postoperative day (POD) or intensive care unit (ICU) discharge. The secondary objectives were to compare the ventilation duration (VD), length of ICU stay (LOICUS), length of hospital stay (LOHS), macronutrient consumption, adverse events, sepsis, and mortality between the two groups.
This study was a parallel-group, open-labeled, single-blinded, variable block size RCT conducted at a tertiary care teaching hospital in northern India. Full-term breastfed infants ≤6 months, weighing ≥2.5 kg at birth, and undergoing congenital cardiac repair were enrolled in this study. The infants were fed either EBM or supplemented EBM in control and intervention groups, respectively. Weight and length were measured at baseline and 15 POD or at ICU discharge. Biochemical parameters at baseline and every alternate day, sepsis parameters every third POD and VD, LOICUS, LOHS, macronutrient consumption, and adverse events were assessed daily.
The mean weight, weight change percentage, and weight for age z score were significantly higher in the supplemented EBM group ( < 0.05). The macronutrient consumption was significantly higher in the intervention group ( < 0.05). No significant difference was found between the two groups for VD, LOICUS, and LOHS ( > 0.05). The sepsis was higher in the EBM group. However, the mortality rate did not differ between the two groups ( > 0.05).
Supplemented feeding may improve the weight of postoperative cardiac infants with no serious adverse events.
先天性心脏病（CHD）相关的营养不良是CHD的一种全身性后果。目前缺乏满足营养需求的饮食建议。本随机对照试验（RCT）旨在确定早期经口喂养补充挤母乳（suppl-EBM）与挤母乳（EBM）相比，对改善心脏手术后婴儿体重的效果。
主要目的是比较EBM组和suppl-EBM组在术后第15天（POD）或重症监护病房（ICU）出院时的体重变化。次要目的是比较两组之间的通气持续时间（VD）、ICU住院时间（LOICUS）、住院时间（LOHS）、常量营养素消耗、不良事件、败血症和死亡率。
本研究是在印度北部一家三级护理教学医院进行的平行组、开放标签、单盲、可变区组大小的RCT。纳入出生体重≥2.5 kg、≤6个月的足月母乳喂养且接受先天性心脏修复手术的婴儿。对照组和干预组婴儿分别喂养EBM或补充EBM。在基线和术后第15天或ICU出院时测量体重和身长。在基线和每隔一天测量生化参数，每隔第三个POD测量败血症参数，并每日评估VD、LOICUS、LOHS、常量营养素消耗和不良事件。
suppl-EBM组的平均体重、体重变化百分比和年龄别体重Z评分显著更高（<0.05）。干预组的常量营养素消耗显著更高（<0.05）。两组之间的VD、LOICUS和LOHS无显著差异（>0.05）。EBM组的败血症发生率更高。然而，两组之间的死亡率无差异（>0.05）。
补充喂养可能改善心脏手术后婴儿的体重，且无严重不良事件。
