Low Energy Intakes Are Associated With Adverse Outcomes in Infants After Open Heart Surgery

Background: Infants with congenital heart lesions who undergo open heart surgery may experience physiologic and metabolic stress in the postoperative period, leading to altered metabolism and hypercatabolism. The purpose of this study was to determine the relationship between energy intake and hospital outcomes during the first 10 days following neonatal open heart surgery. Materials and Methods: A post hoc analysis of all patients in a prospective randomized controlled trial was performed. Nutrition intake and hospital outcomes were assessed in 32 infants (40 +/- 2.2 weeks, 3.4 +/- 0.5 kg) in the neonatal and pediatric intensive care units. Infants received parenteral nutrition (PN) for 1-4 days before and 10 days after open heart surgery. Infants were separated into those who received a cumulative energy intake of <689 kcal (average 63 kcal/kg/d) and those who received an intake >= 689 kcal during postoperative days 0-10. Results: Lower energy intake was associated with a significantly increased duration of artificial ventilation (5 +/- 1.2 days), time to chest closure (1.4 +/- 0.5 days), time in intensive care (5 +/- 1.8 days), and stay in the hospital (25 +/- 6.4 days). Lower energy intake was also associated with a significant increase in the length of time infants required PN (8 +/- 2.9 days) and longer time to achieve full enteral intake of 100 mL/kg/d (7 +/- 2.2 days) and before enteral feeds could be initiated (5 +/- 1.5 days). Conclusions: Providing <63 kcal/kg/d to infants after open heart surgery was associated with adverse pediatric intensive care outcomes. (JPEN J Parenter Enteral Nutr. 2013;37:254-260)