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Preoperative Feeds in Ductal-Dependent Cardiac Disease: A Systematic Review and Meta-analysis
Jasmeet Kataria-Hale1, Scott Webb Osborne2, Amy Hair2
1Section of Neonatology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas kataria@bcm.edu.
Insights
Preoperative enteral feeds in neonates with ductal-dependent congenital heart disease do not appear to significantly impact necrotizing enterocolitis, hospital length of stay, or feeding intolerance, according to current evidence.
Area of Science:
- Pediatric Cardiology
- Neonatal Surgery
- Gastroenterology
Background:
- Ductal-dependent congenital heart disease (DDCHD) requires critical management in neonates.
- Preoperative feeding practices in these vulnerable infants are debated.
- Understanding the impact of preoperative nutrition is crucial for optimizing outcomes.
Purpose of the Study:
- To review and summarize existing evidence on the safety and efficacy of preoperative enteral feeds in neonates with DDCHD.
- To determine if preoperative feeding is associated with adverse outcomes such as necrotizing enterocolitis (NEC), prolonged hospital length of stay (LOS), or feeding intolerance.
Main Methods:
- A systematic review of observational studies was conducted.
- Databases searched included Medline, Embase, and Cochrane Central Register of Controlled Trials.
- Outcomes assessed were NEC, hospital LOS, time to full postoperative enteral feeding, and feeding intolerance.
Main Results:
- Five retrospective cohort studies were included, all with significant risk of bias and small sample sizes.
- No significant differences were found in NEC rates, hospital LOS, or feeding intolerance between neonates receiving preoperative feeds and those who did not.
- Evidence certainty for all outcomes was assessed as very low.
Conclusions:
- Current evidence is insufficient to conclude that preoperative enteral feeds adversely affect NEC, LOS, or feeding intolerance in neonates with DDCHD.
- Further high-quality research, particularly randomized controlled trials, is needed to establish definitive guidelines.
Context:
Our aim for this review is to determine if preoperative feeds in neonates with ductal-dependent congenital heart disease are harmful or beneficial.
Objectives:
To summarize current evidence for preoperative feeding in neonates with ductal-dependent congenital heart disease.
Data Sources:
We used the following databases: Medline, Embase, and Cochrane Central Register of Controlled Trials.
Study Selection:
We included observational studies in which the following outcomes were addressed: necrotizing enterocolitis (NEC), hospital length of stay (LOS), time to achieve full postoperative enteral feeding, and feeding intolerance.
Data Extraction:
Two reviewers independently screened each study for eligibility and extracted data. Methodologic quality was assessed by using a standardized item bank, and certainty of evidence for each outcome was assessed by using Grading of Recommendations Assessment, Development and Evaluation criteria.
Results:
Five retrospective cohort studies were eligible for inclusion, for which risk of bias was significant. When comparing neonates who received preoperative feeds with those who did not, there was no significant difference in NEC (pooled odds ratio = 1.09 [95% confidence interval 0.06-21.00; P = .95]; 3 studies, 6807 participants, very low certainty evidence), hospital LOS (mean of 14 days for those not fed versus 9.9 days for those fed preoperatively; P < .01; 1 study, 57 participants, very low certainty evidence), or feeding intolerance (odds ratio = 2.014 [95% confidence interval 0.079-51.703; P = .67]; 1 study, 56 participants, very low certainty evidence). No data were available for the outcome time to achieve full postoperative enteral feeding. All studies were observational and had small sample sizes.
Conclusions:
There is insufficient evidence to suggest that preoperative enteral feeds in patients with ductal-dependent cardiac lesions adversely influence the rate of NEC, LOS, or feeding intolerance.
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