Abstract：
High-energy or high-protein feeding offers a promising approach to improving malnutrition in children after congenital heart surgery. However, the effect of high-energy or high-protein feeding in this population has not yet been systematically reviewed. Therefore, we aimed to assess the safety and effectiveness of high-energy or high-protein feeding in children after congenital heart surgery. Five electronic databases (PubMed, Embase, CENTRAL, CINAHL, and Scopus) were searched from inception to April 23, 2022. After screening the literature according to inclusion and exclusion criteria, a risk of bias assessment was performed using version 2 of the Cochrane risk-of-bias tool for randomized trials, and the certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations system. Finally, the random effects model was used to perform a meta-analysis of all data. A total of 609 subjects from 9 studies were included for qualitative analysis, and meta-analyses were performed on data from 8 of these studies. The results showed that high-energy and/or high-protein feeding did not increase feeding intolerance (RR = 1.09, 95% CI: 0.80, 1.48) or fluid intake (MD = - 12.50 ml/kg/d, 95% CI: - 36.10, 11.10); however, the intervention was beneficial in increasing weight (MD = 0.5 kg, 95% CI: 0.23, 0.77) and reducing the duration of mechanical ventilation (MD = - 17.45 h, 95% CI: - 27.30, - 7.60), intensive care unit (ICU) stay (MD = - 1.45 days, 95% CI: - 2.36, - 0.54) and hospital stay (MD = - 2.82 days, 95% CI: - 5.22, - 0.43). However, high-energy and/or protein feeding did not reduce the infection rate (RR = 0.68, 95% CI: 0.25, 1.87) or mortality (RR = 1.50, 95% CI: 0.47, 4.82).
CONCLUSIONS: The certainty of the evidence was graded as moderate to high, which suggests that high-energy and/or high-protein feeding may be safe in children after congenital heart surgery. Furthermore, this intervention improves nutrition and reduces the duration of mechanical ventilation, length of ICU stay, and length of hospital stay. However, the overall conclusion of this meta-analysis will need to be confirmed in a cohort of patients with different cardiac physiologies.
BACKGROUND: • Malnutrition is highly prevalent in children with congenital heart disease (CHD) and can negatively affect the prognosis of these children. • High-energy and/or high-protein feeding can improve nutrition status and facilitate recovery; however, evidence on its safety and efficacy is lacking.
BACKGROUND: • Pooled data suggest that high-energy and/or high-protein feeding does not increase fluid intake or feeding intolerance in children with CHD. • High-energy and/or high-protein feeding may reduce the duration of mechanical ventilation, length of intensive care unit stay, and length of hospital stay.
CONCLUSIONS: The certainty of the evidence was graded as moderate to high, which suggests that high-energy and/or high-protein feeding may be safe in children after congenital heart surgery. Furthermore, this intervention improves nutrition and reduces the duration of mechanical ventilation, length of ICU stay, and length of hospital stay. However, the overall conclusion of this meta-analysis will need to be confirmed in a cohort of patients with different cardiac physiologies.
BACKGROUND: • Malnutrition is highly prevalent in children with congenital heart disease (CHD) and can negatively affect the prognosis of these children. • High-energy and/or high-protein feeding can improve nutrition status and facilitate recovery; however, evidence on its safety and efficacy is lacking.
BACKGROUND: • Pooled data suggest that high-energy and/or high-protein feeding does not increase fluid intake or feeding intolerance in children with CHD. • High-energy and/or high-protein feeding may reduce the duration of mechanical ventilation, length of intensive care unit stay, and length of hospital stay.
摘要：
高能量或高蛋白喂养为改善先天性心脏病手术后儿童营养不良提供了一种有希望的方法。然而,高能量或高蛋白喂养对该人群的影响尚未进行系统评价.因此,我们旨在评估先天性心脏病手术后儿童接受高能量或高蛋白喂养的安全性和有效性.五个电子数据库(PubMed，Embase,中部,CINAHL,和Scopus)从成立之初到2022年4月23日进行了搜索。根据纳入和排除标准筛选文献后，偏倚风险评估使用Cochrane偏倚风险工具的第2版进行随机试验,证据的确定性是使用建议分级来评估的，评估,开发和评估系统。最后,使用随机效应模型对所有数据进行荟萃分析.共纳入9项研究的609名受试者进行定性分析，对其中8项研究的数据进行荟萃分析.结果表明，高能量和/或高蛋白喂养不会增加喂养不耐受（RR=1.09，95％CI：0.80，1.48）或液体摄入量（MD=-12.50ml/kg/d，95%CI：-36.10，11.10)；然而，干预有利于增加体重(MD=0.5kg，95％CI：0.23，0.77）和减少机械通气的持续时间（MD=-17.45h，95%CI：-27.30，-7.60），重症监护病房（ICU）住院（MD=-1.45天，95%CI：-2.36，-0.54）和住院时间（MD=-2.82天，95%CI：-5.22，-0.43）。然而,高能量和/或蛋白质喂养并没有降低感染率(RR=0.68,95%CI:0.25,1.87)或死亡率(RR=1.50,95%CI:0.47,4.82).
结论：证据的确定性被分级为中等到高，这表明高能量和/或高蛋白喂养在先天性心脏病手术后的儿童中可能是安全的。此外，这种干预改善了营养并减少了机械通气的持续时间，ICU住院时间,和住院时间。然而,本荟萃分析的总体结论需要在不同心脏生理参数的患者队列中得到证实.
背景：•营养不良在患有先天性心脏病（CHD）的儿童中非常普遍，并且会对这些儿童的预后产生负面影响。•高能量和/或高蛋白喂养可以改善营养状况并促进恢复;然而，缺乏关于其安全性和有效性的证据。
背景：•汇总数据表明，高能量和/或高蛋白喂养不会增加CHD儿童的液体摄入量或喂养不耐受。•高能量和/或高蛋白喂养可能会减少机械通气的持续时间，重症监护病房住院时间,和住院时间。
结论：证据的确定性被分级为中等到高，这表明高能量和/或高蛋白喂养在先天性心脏病手术后的儿童中可能是安全的。此外，这种干预改善了营养并减少了机械通气的持续时间，ICU住院时间,和住院时间。然而,本荟萃分析的总体结论需要在不同心脏生理参数的患者队列中得到证实.
背景：•营养不良在患有先天性心脏病（CHD）的儿童中非常普遍，并且会对这些儿童的预后产生负面影响。•高能量和/或高蛋白喂养可以改善营养状况并促进恢复;然而，缺乏关于其安全性和有效性的证据。
背景：•汇总数据表明，高能量和/或高蛋白喂养不会增加CHD儿童的液体摄入量或喂养不耐受。•高能量和/或高蛋白喂养可能会减少机械通气的持续时间，重症监护病房住院时间,和住院时间。
