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Is a semi-elemental diet better than a polymeric diet after congenital heart surgery?
Shancy Rooze1, Sid Ali Namane2, Xavier Beretta3
1Pediatric Intensive Care Unit, Queen Fabiola Children's University Hospital, Avenue JJ Crocq 15, 1020, Brussels, Belgium. shancy.rooze@huderf.be.
Insights
Children fed semi-elemental or polymeric diets after congenital heart surgery showed similar feeding tolerance and energy delivery. This suggests both nutritional options are equally effective for pediatric intensive care unit patients recovering from cardiac procedures.
Area of Science:
- Pediatric critical care medicine
- Surgical nutrition
- Gastroenterology
Background:
- Nutrition plays a vital role in patient outcomes within the pediatric intensive care unit (PICU).
- Various specialized diets have been explored for children with intestinal issues or congenital heart disease (CHD), yet none have demonstrated superior feeding tolerance.
- Optimal nutritional support is crucial for recovery following complex pediatric cardiac surgery.
Purpose of the Study:
- To compare the feeding tolerance and energy delivery between semi-elemental and polymeric diets in children post-congenital heart surgery (CHS).
- To evaluate the impact of different enteral formulas on clinical outcomes in a pediatric intensive care setting.
Main Methods:
- A retrospective observational study analyzed data from 100 children (aged 2 days to 6 years) who underwent CHS.
- Patients received either a semi-elemental diet (n=56) or a polymeric diet (n=44) between February 2014 and May 2016.
- Feeding tolerance was assessed by monitoring emesis and diarrhea, with intolerance defined by specific thresholds; energy delivery was tracked against caloric targets.
Main Results:
- Feeding tolerance was comparable between the semi-elemental and polymeric diet groups, with similar rates of emesis (14.3% vs. 6.8%) and diarrhea (3.6% vs. 4.5%).
- Energy delivery also showed no significant difference, with both groups achieving approximately 50% of caloric targets by postoperative day 2 and reaching nutritional goals by day 10.
- No cases of necrotizing enterocolitis were reported in either diet group.
Conclusions:
- Semi-elemental and polymeric diets exhibit similar feeding tolerance in pediatric patients following congenital heart surgery.
- The choice between semi-elemental and polymeric diets does not appear to significantly impact short-term nutritional delivery or tolerance in this population.
- Further research may explore long-term outcomes and specific patient subgroups that might benefit from one diet over the other.
Abstract:
A retrospective observational study has been set up in order to compare feeding tolerance and energy delivery in children fed with a semi-elemental diet or a polymeric diet after congenital heart surgery. The study took place in the intensive care unit of a tertiary children's hospital. One hundred children were included: 56 received a semi-elemental diet and 44 received a polymeric diet. Patients were aged between 2 days and 6 years. Data from patients were obtained from medical files between February 2014 and May 2016. The feeding protocol was changed in March 2015 when a semi-elemental diet was substituted for the polymeric diet. Primary outcome was the feeding tolerance. Feeding intolerance occurs if the patient has more than two episodes of emesis or more than four liquid stools per day. Feeding tolerance in the semi-elemental and polymeric diet groups was comparable: emesis occurred in 14.3% versus 6.8% of patients, respectively (p = 0.338); diarrhea occurred in 3.6% versus 4.5% (p = 1000); post-pyloric feeding was necessary in 14% versus 9% (p = 0.542). Energy delivery was also comparable in the two groups: on postoperative day 2, the semi-elemental diet group reached 50% of the caloric target versus 52% in the polymeric diet group (p = 0.283); on day 5, 76% versus 85% (p = 0.429); and on day 10, 105% versus 125% (p = 0.397). Energy delivery was insufficient on postoperative days 2 and 5, but nutritional goals were achieved by day 10. No patient developed necrotizing enterocolitis in our population.Conclusion: the present study suggests that the feeding tolerance to a semi-elemental or a polymeric diet is similar after CHS.What is Known:•Nutrition can modify prognosis in PICU•Different types of diet have been tested in children with intestinal disorders or with congenital heart disease. None of these diets have shown to be superior in terms of feeding tolerance.What is New:•Semi elemental and polymeric diets seem to have the same feeding tolerance in PICU after cardiac surgery for congenital heart disease.
