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Biomarkers for feeding intolerance in infants with complex heart defects undergoing palliation surgery
Katarzyna Bigaj1,2, Alvaro Coronado Munoz3, Yuying Liu2
1Department of Pediatrics, Gastroenterology, The Children's Hospital at Montefiore Einstein, Bronx, New York, USA.
Insights
Serum biomarkers like claudin-3 and intestinal fatty acid-binding protein (I-FABP) can predict post-operative feeding intolerance in infants with congenital heart disease (CHD). Early identification may optimize feeding protocols and reduce complications like necrotizing enterocolitis (NEC).
Area of Science:
- Pediatric Cardiology
- Gastroenterology
- Surgical Critical Care
Background:
- Feeding intolerance (FI) is a common complication in infants with congenital heart disease (CHD) post-cardiac surgery.
- Early identification of infants at risk for FI is crucial for optimizing nutritional support and preventing adverse outcomes like necrotizing enterocolitis (NEC).
Purpose of the Study:
- To evaluate serum biomarkers reflecting intestinal membrane integrity as predictors of post-operative feeding intolerance (FI) in infants with CHD.
- To assess the sequential changes in biomarkers of tight junction integrity (claudin-3) and villus injury (I-FABP) in relation to FI development.
Main Methods:
- Infants (≥35 weeks gestational age, 0-6 months) with complex CHD undergoing palliation surgery were enrolled.
- Blood samples were collected pre-feeding, at 7 and 14 days post-feeding initiation, and upon symptoms of FI/NEC.
- Plasma levels of claudin-3 and I-FABP were analyzed alongside clinical outcomes.
Main Results:
- Infants who developed FI had significantly higher peak claudin-3 levels and elevated claudin-3 throughout the 28-day post-surgery period compared to controls.
- Pre-feeding I-FABP levels were higher in the FI group.
- Longer cardiopulmonary bypass time and higher maximal lactate levels were associated with FI.
- Infants with FI had lower weight-for-length at discharge.
Conclusions:
- Sequential measurement of plasma I-FABP and claudin-3 may predict the risk of feeding intolerance in children with CHD after cardiac surgery.
- These biomarkers could aid in optimizing feeding protocols to reduce complications such as NEC.
- Further validation in larger cohorts is warranted.
Objectives:
We evaluated whether serum biomarkers reflecting intestinal membrane integrity will serve as predictors for post-operative feeding intolerance (FI) in patients with congenital heart disease (CHD).
Methods:
We enrolled infants ≥ 35 weeks gestational age, aged 0-6 months, with complex CHD undergoing palliation surgery. After surgery, blood samples were obtained prior to the initiation of enteral feeds, at 7 and 14-days post feeding initiation, and at times of symptoms of FI and/or necrotizing enterocolitis (NEC). Plasma biomarkers of tight junction integrity (claudin-3), villus injury (I-FABP), and clinical outcomes were analyzed.
Results:
Twenty-four infants were included in the analysis, and twelve of those had FI and/or symptoms of NEC. Patients in the FI group had higher peak claudin-3 than controls (p < 0.001). Claudin-3 was overall higher during 28 days after surgery in patients with FI. Pre-feeding I-FABP levels were higher for the FI group vs. control group (p = 0.006) but did not rise afterward. Higher cardiopulmonary bypass time and maximal lactate was associated with FI. Weight for length at discharge was significantly lower in patients with FI.
Conclusions:
We suggest that, when measured sequentially, plasma levels of I-FABP and claudin-3 may help to predict children with CHD at risk of feeding intolerance post cardiac surgery. If further validated in larger cohort, these biomarkers may aid in optimizing feeding protocols aimed at reducing sequelae such as NEC.
