Congenital heart disease prolongs the time to full enteral feeding in neonates with abdominal operation: a dual-center, propensity score-matched retrospective cohort study

Background Congenital heart disease (CHD) may cause intestinal hypoperfusion and feeding intolerance. The aim of this study was to assess whether CHD prolongs the time to achieve full enteral feeding in neonates underwent abdominal surgery. Methods This was a dual-center retrospective study. Neonates who underwent abdominal surgery were subdivided into two groups: those with CHD and those without. The primary outcome was the time to achieve full enteral feeding after abdominal surgery. Propensity score matching (ratio of 1:2) was performed to balance covariates. Cox regression analysis was used to evaluate the association. Subgroup analysis further stratified CHD patients based on hemodynamic significance as determined by echocardiographic criteria. Results A total of 341 newborns were enrolled: 136 with CHD and 205 without. For infants with vs. without CHD, the median gestational age was 35.6 (32.4, 37.8) weeks vs. 36.6 (32.1, 39.0) weeks, birth weight was 2270.0 (1547.5, 3007.5) vs. 2630.0 (1700.0, 3300.0) g, corrected gestational age on surgery day was 37.2 (34.2, 39.4) weeks vs. 39.0 (35.1, 41.4) weeks, respectively (all P < 0.05). There was no significant difference between 2 groups in preoperative feeding nor in operation duration (both P > 0.05). After propensity score matching, 64 neonates with CHD and 128 without CHD were compared. The postoperative time to achieve full feeding was 21.6 days ( 95% CI : 15.1 ~ 28.1) for CHD and 17.4 ( 95% CI : 14.2 ~ 20.7) days for non-CHD ( P = 0.014). Multivariable analysis found that CHD was an independent risk factor ( HR = 2.046, 95% CI : 1.189 ~ 3.519, P = 0.010). Subgroup analysis revealed that only hemodynamically significant CHD ( HR = 2.712, 95% CI : 1.414 ~ 5.198, P = 0.003) contributed to this association, while non-significant CHD did not ( HR = 1.112, 95% CI : 0.523 ~ 2.370, P = 0.781). Conclusions The presence of CHD significantly prolongs the time to achieve full enteral feeding postoperatively and increases the risk of feeding intolerance in neonates undergoing abdominal surgery, an effect primarily driven by hemodynamically significant CHD. Trial registration This study was registered in the Chinese Clinical Trial Registry on November 8, 2025 (Registry website: http://www.chictr.org.cn ) (Registration No. ChiCTR2500112685).