The Impact of Early Enteral Nutrition on Post-operative Hospital Stay and Complications in Infants Undergoing Congenital Cardiac Surgery: A Systematic Review and Meta-analysis

Introduction: The congenital cardiac diseases (CHDs) are the leading cause of death in children. The CHDs detection and management have greatly improved over the past few decades. This review aimed to assess the effectiveness of early enteral nutrition (EEN) on postoperative outcomes in infants undergoing congenital cardiac surgery. Methods: Electronic databases PubMed, Clinical Key, UpToDate, the Cochrane Library, and Google Scholar were searched for studies published in the English language, between 2004 and 2021. This review carried out based on PRISMA statement and studies qualities assessed using "Downs and Black score". Hospital stay, intensive care unit (ICU) stay, mechanical ventilation support, aortic cross clamping and cardiopulmonary bypass were as primary outcomes. Similarly infections, vomiting and mortality were as secondary outcomes of included studies. Results: This review consists of 887 infants from 10 studies. Of these, 470 infants were assigned to the intervention group and 417 to the control group. The post-operative hospital stay shorted in the EEN group than the control group (SMD=-0.63, 95% CI: -1.03 to -0.22, P=0.0, I(2)=87%). Similarly, EEN group lessen the ICU stay (SMD=-0.15, 95% CI: -0.42, 0.11, P=0.0, I(2)=71%), mechanical ventilation support (SMD=-0.31, 95% CI: -0.51, -08, P=0.08, I(2)=47%), aortic cross clamping (SMD=-0.92, 95% CI: -0.31, 2.4, P=0.00, I(2)=96%), and cardiopulmonary bypass (SMD=-0.0, 95% CI: -0.42 to 43, P=0.00, I(2)=71%). Secondary postoperative complications such as infections (RR=0.68, 95% CI: 0.43 to 1.08, P=0.40, I(2)=3%). vomiting (RR=1.47, 95% CI: 0.80 to 2.69, P=0.90, I(2)=0%) and postoperative mortality (RR=0.42, 95% CI: 0.03 to 5.82, P=0.00: I(2)=80%) significantly reduced. Conclusion: Postoperative outcomes were improved in the intervention group compared to the control group, including shorter hospital stays, ICU stays, mechanical ventilation, and less postoperative complications.