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Review
. 2022 Nov 29;9(12):1856.
doi: 10.3390/children9121856.

Feeding Neonates and Infants Prior to Surgery for Congenital Heart Defects: Systematic Review and Meta-Analysis

Douglas Bell  1 , Jessica Suna  2   3   4 , Supreet P Marathe  2   3   4 , Gopinath Perumal  5 , Kim S Betts  4 , Prem Venugopal  2   3   4 , Nelson Alphonso  2   3   4 , Qpcr Group  6
Affiliations
Review

Feeding Neonates and Infants Prior to Surgery for Congenital Heart Defects: Systematic Review and Meta-Analysis

Douglas Bell et al. Children (Basel). .

Abstract

Background: Necrotising enterocolitis (NEC) is a significant cause of mortality and morbidity in neonates requiring cardiac surgery. Feeding practices vary significantly across institutions and remain controversial. We conducted a systematic review of the literature and a meta-analysis to identify associations between feeding practices and necrotising enterocolitis.

Methods: This study was carried out in accordance with the PRISMA guidelines. A literature search was performed in November 2022 using the Cochrane Central Register, Embase, and Pubmed. Two investigators then independently retrieved eligible manuscripts considered suitable for inclusion. Data extracted included gestational age, birth weight, sex, nature of congenital heart lesion, type of operation performed, time on ventilator, ICU stay, hospital stay, post-operative feeding strategy, and complications. The methodological quality was assessed using the Downs and Black score for all randomised control trials and observational studies.

Results: The initial search yielded 92 studies. After removing duplicates, there were 85 abstracts remaining. After excluding ineligible studies, 8 studies were included for the meta-analysis. There was no significant risk of NEC associated with pre-operative feeding [OR = 1.22 (95% CI 0.77,1.92)] or umbilical artery catheter placement [OR = 0.91 (95% CI 0.44, 1.89)] and neither outcome exhibited heterogeneity [I2 = 8% and 0%, respectively]. There was a significant association between HLHS and NEC [OR = 2.56 (95% CI 1.56, 4.19)] as well as prematurity and NEC [OR 3.34 (95% CI 1.94, 5.75)] and neither outcome exhibited heterogeneity [I2 = 0% and 0%, respectively].

Conclusions: There was no association between NEC and pre-operative feeding status in neonates awaiting cardiac surgery. Pre-operative feeding status was not associated with prolonged hospital stay or need for tube assisted feeding at discharge. HLHS and prematurity were associated with increased incidence of NEC.

Keywords: cardiac surgery; congenital heart disease; feeding; necrotizing enterocolitis; neonates.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram of search strategy. Terms: [Enteral feeding] AND [Cardiac Surgery] OR [congenital heart disease] AND [Necrotising Enterocolitis] AND [neonates OR infants].
Figure 2
Figure 2
Forest plot (a) and funnel plot (b) of study effect estimates for preoperative feeding and NEC [shown as odds ratios and log (odds ratios), respectively] [5,21,22,23,24,25,26,27]. Egger’s test did not indicate funnel plot asymmetry [p = 0.769].
Figure 3
Figure 3
Forest plot (a) and funnel plot (b) of study effect estimates for hypoplastic left heart syndrome and NEC [shown as odds ratios and log (odds ratios), respectively] [5,23,24,25,26]. Egger’s test did not indicate funnel plot asymmetry [p = 0.633].
Figure 4
Figure 4
Forest plot (a) and funnel plot (b) of study effect estimates for umbilical catheter and NEC [shown as odds ratios and log (odds ratios), respectively] [5,23,24]. Egger’s test did not indicate funnel plot asymmetry [p = 0.914].
Figure 5
Figure 5
Forest plot (a) and funnel plot (b) of study effect estimates for premature birth and NEC [shown as odds ratios and log (odds ratios), respectively] [5,24,25,26]. Egger’s test did not indicate funnel plot asymmetry [p = 0.581].
See this image and copyright information in PMC

References

    1. Giannone P.J., Luce W.A., Nankervis C.A., Hoffman T.M., Wold L.E. Necrotizing enterocolitis in neonates with congenital heart disease. Life Sci. 2008;82:341–347. doi: 10.1016/j.lfs.2007.09.036. - DOI - PubMed
    1. del Castillo S.L., McCulley M.E., Khemani R.G., Jeffries H.E., Thomas D.W., Peregrine J., Wells W.J., Starnes V.A., Moromisato D.Y. Reducing the incidence of necrotizing enterocolitis in neonates with hypoplastic left heart syndrome with the introduction of an enteral feed protocol. Pediatr. Crit. Care Med. 2009;11:373–377. doi: 10.1097/PCC.0b013e3181c01475. - DOI - PubMed
    1. Shulhan J., Dicken B., Hartling L., Larsen B.M. Current knowledge of necrotizing enterocolitis in preterm infants and the impact of different types of enteral nutrition products. Adv. Nutr. 2017;8:80–91. doi: 10.3945/an.116.013193. - DOI - PMC - PubMed
    1. Carlo W.F., Kimball T.R., Michelfelder E.C., Border W.L. Persistent diastolic flow reversal in abdominal aortic Doppler-flow profiles is associated with an increased risk of necrotizing enterocolitis in term infants with congenital heart disease. Pediatrics. 2007;119:330–335. doi: 10.1542/peds.2006-2640. - DOI - PubMed
    1. McElhinney D.B., Hedrick H.L., Bush D.M., Pereira G.R., Stafford P.W., Gaynor J.W., Spray T.L., Wernovsky G. Necrotizing enterocolitis in neonates with congenital heart disease: Risk factors and outcomes. Pediatrics. 2000;106:1080–1087. doi: 10.1542/peds.106.5.1080. - DOI - PubMed