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Is a semi-elemental diet better than a polymeric diet after congenital heart surgery?

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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.

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Abbreviations

CHD:

Congenital heart disease

CHS:

Congenital heart surgery

CPB:

Cardiopulmonary bypass

H/A:

Height for age

PD:

Polymeric diet

PICU:

Paediatric intensive care unit

PIM:

Paediatric index of mortality

PRISM:

Paediatric risk of mortality

NEC:

Necrotizing enterocolitis

RACHS:

Risk adjustment for in-hospital mortality among children younger than 18 years after surgery for congenital heart disease

SED:

Semi-elemental diet

WHO:

World Health Organization

W/H:

Weight for height

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Authors and Affiliations

  1. Pediatric Intensive Care Unit, Queen Fabiola Children’s University Hospital, Avenue JJ Crocq 15, 1020, Brussels, Belgium

    Shancy Rooze, Xavier Beretta, Alfredo Vicinanza, Daphné Vens, Cédric Voglet, Ariane Willems & Dominique Biarent

  2. Nutrition and Metabolism Unit, Queen Fabiola Children’s University Hospital, Avenue JJ Crocq 15, 1020, Brussels, Belgium

    Sid Ali Namane & Philippe Goyens

Authors
  1. Shancy Rooze
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  2. Sid Ali Namane
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Contributions

Shancy Rooze: formulated the research question, designed and conducted the study and wrote the manuscript.

Namane Sid Ali: was in charge of the dietetic follow-up of the patients during their PICU stay.

Xavier Berretta: provided clinical care to the patients during their PICU stay and accepted the final version of the manuscript.

Alfredo Vicinanza: provided clinical care to the patients during their PICU stay and accepted the final version of the manuscript.

Daphné Vens: provided clinical care to the patients during their PICU stay and accepted the final version of the manuscript.

Cédric Voglet: provided clinical care to the patients during their PICU stay and accepted the final version of the manuscript.

Ariane Willems: provided clinical care to the patients during their PICU stay and accepted the final version of the manuscript.

Philippe Goyens: formulated the research question and designed and conducted the study and accepted the final version of the manuscript

Dominique Biarent: formulated the research question, and designed and conducted the study and accepted the final version of the manuscript.

Corresponding author

Correspondence to Shancy Rooze.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the ethics committee of the Queen Fabiola Children’s University Hospital (CEH 18/15).

Informed consent

The ethics committee of the Queen Fabiola Children’s University Hospital waived the need for parental consent.

Additional information

Communicated by Piet Leroy

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Rooze, S., Namane, S.A., Beretta, X. et al. Is a semi-elemental diet better than a polymeric diet after congenital heart surgery?. Eur J Pediatr 179, 423–430 (2020). https://doi.org/10.1007/s00431-019-03505-6

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  • DOI: https://doi.org/10.1007/s00431-019-03505-6

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