What question did this study set out to answer?

This study evaluates the effect of early versus delayed enteral nutrition on infection rates and nutritional outcomes in children after heart surgery.

June 17, 2026Open Access

Impact of early postoperative enteral nutrition initiation timing on infection rate and nutritional status in children with congenital heart disease

Q: What does this research mean for the field?

Early enteral nutrition initiation within 24 hours after congenital heart disease surgery in pediatric patients is associated with reduced infection rates, improved nutritional status, and shorter hospital stays compared to delayed initiation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Points

This study evaluates the effect of early versus delayed enteral nutrition on infection rates and nutritional outcomes in children after heart surgery.
Retrospective cohort study of 246 children aged 1 month to 3 years undergoing congenital heart surgery.
Early enteral nutrition group initiated within 24 hours post-surgery; delayed group after 24 hours.
Primary outcomes: postoperative infection rate and nutritional parameters.
Early enteral nutrition group had lower nosocomial infection rate (14.84% vs. 27.12%, P = 0.016).
Higher serum albumin levels on postoperative day 7 in early group (35.62 ± 4.18 vs. 32.47 ± 5.23 g/L, P < 0.001).
Shorter ICU stay in early group (5.38 ± 2.14 vs. 7.25 ± 3.42 days, P < 0.001).

Abstract

The optimal timing for initiating enteral nutrition after congenital heart disease surgery remains controversial. This study aimed to evaluate the impact of early versus delayed enteral nutrition initiation on postoperative infection rate and nutritional status in pediatric congenital heart disease patients. A retrospective cohort study was conducted on 246 children (aged 1 month to 3 years) who underwent congenital heart disease surgery between January 2021 and December 2023. Patients were divided into early enteral nutrition group (enteral nutrition initiated ≤ 24 h postoperatively, n = 128) and delayed enteral nutrition group (enteral nutrition initiated > 24 h postoperatively, n = 118). Primary outcomes included postoperative infection rate and nutritional parameters. Secondary outcomes included ICU length of stay, hospital length of stay, and mechanical ventilation duration. The early enteral nutrition group demonstrated significantly lower nosocomial infection rate (14.84% vs. 27.12%, P = 0.016) and surgical site infection rate (3.91% vs. 10.17%, P = 0.047). Postoperative day 7 serum albumin (35.62 ± 4.18 vs. 32.47 ± 5.23 g/L, P < 0.001) and prealbumin levels (168.35 ± 42.67 vs. 142.58 ± 38.94 mg/L, P < 0.001) were significantly higher in the early enteral nutrition group. The early enteral nutrition group also showed shorter ICU stay (5.38 ± 2.14 vs. 7.25 ± 3.42 days, P < 0.001) and hospital stay (12.45 ± 4.36 vs. 16.82 ± 5.78 days, P < 0.001). Multivariate logistic regression identified delayed enteral nutrition initiation as an independent risk factor for nosocomial infection (OR = 2.18, 95% CI: 1.12–4.24, P = 0.022). In this retrospective cohort study, early enteral nutrition initiation within 24 h after congenital heart disease surgery was associated with reduced infection rates, improved nutritional status, and shorter hospital stay in pediatric patients, predominantly those undergoing repair of septal defects. These observations suggest a potential benefit of early enteral nutrition in selected pediatric cardiac surgery patients; however, prospective validation is warranted before broad implementation, given the inherent limitations of the retrospective design and the predominantly lower-complexity patient population studied.

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