Abstract：
Background: Infants with congenital heart disease (CHD) are at risk for feeding-related morbidity and mortality, with growth failure and oral feeding problems associated with poor outcomes. The benefits of human milk (HM) for preterm infants have been well documented, but evidence on HM for infants with CHD has recently begun to emerge. Objectives: Our primary aim was to examine the impact of HM feeding on outcomes for infants with CHD. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, a search was conducted using MEDLINE, CINAHL, and Cochrane Database of Systematic Reviews. The quality of each study was assessed using the Joanna Briggs Critical Appraisal Tools. A total of 16 studies were included. Results: There was evidence that an exclusive HM diet reduces the risk of necrotizing enterocolitis (NEC) for infants with CHD. Evidence with a higher risk for bias indicated that a well-managed HM diet may be associated with improved growth, shorter length of stay, and improved postoperative feeding and nutritional outcomes. Chylothorax outcomes were similar between modified HM and medium-chain triglyceride formula. The studies had significant limitations related to power, lack of control for covariates, and inconsistent delineation of feeding groups. Conclusions: Based on the reduced risk for NEC and given the conclusive benefits in other vulnerable populations, we recommend that clinicians and institutions prioritize programs to support HM feeding for infants with CHD. Large high-quality studies are needed to validate these results. Future work should clarify best practices in managing an HM diet to support optimal growth and development for these infants.
摘要：
背景：患有先天性心脏病（CHD）的婴儿有喂养相关的发病率和死亡率的风险，与不良结局相关的生长障碍和口服喂养问题。母乳（HM）对早产儿的益处已得到充分证明。但是最近开始出现关于CHD婴儿的HM的证据。目标：我们的主要目的是研究HM喂养对CHD婴儿结局的影响。方法：遵循PRISMA（系统评价和荟萃分析的首选报告项目）指南，使用MEDLINE进行搜索，CINAHL,和Cochrane系统评价数据库。使用JoannaBriggs关键评估工具评估每个研究的质量。共纳入16项研究。结果：有证据表明，独家HM饮食可降低CHD婴儿坏死性小肠结肠炎（NEC）的风险。偏倚风险较高的证据表明，管理良好的HM饮食可能与改善的生长有关。停留时间较短，并改善术后喂养和营养结果。改良HM和中链甘油三酯配方乳糜胸结果相似。这些研究在功率方面有很大的局限性，缺乏对协变量的控制，喂养组的划分不一致。结论：基于NEC的风险降低，并考虑到其他弱势群体的决定性益处，我们建议临床医生和机构优先考虑支持CHD婴儿的HM喂养计划.需要大量高质量的研究来验证这些结果。未来的工作应该阐明管理HM饮食的最佳实践，以支持这些婴儿的最佳生长和发育。
