The benefits of early enteral feeding in critically-ill term and pre-term infants have been widely recognized. Despite this acumen of information, neonates with PGE1
-dependent congenital cardiac defects are often kept on parenteral nutrition and intestinal rest. Likely this practice is due to lack of objective evidence leading most medical caregivers to the conservative practice of feeding restraint in this unique population (4
), independent of the arterial ductal flow direction. Nevertheless, the effects of such a nutritional strategy in neonates and infants with congenital heart disease who require continuous PGE1
-therapy are not known. Infants are consequently maintained on parenteral nutrition due to the presumed complications associated with feeding in this fragile population, namely necrotizing enterocolitis (NEC). Previous studies have endeavored to define the relationship between NEC and congenital heart disease. A retrospective review of 643 neonates with heart disease identified factors associated with an elevated risk of NEC (5
). The factors that were recognized were: premature birth, hypoplastic left heart syndrome, truncus arteriosus and episodes of poor systemic perfusion or shock. Of note, it was observed that neonates with cardiac disease who develop NEC supposedly experience intestinal ischemia either by their pathophysiology or by an episode of decreased systemic perfusion.
Balance between the hypothetical complications of feeding neonates on PGE1 infusions and the clear advantages of enteral feeding motivated the medical caregivers in our Institution to initiate presurgical enteral feeding in PGE1-dependent term neonates, beginning in March 2007. We were encouraged by the results of this practice, with 33 of 34 (97%) neonates with PGE1-dependent cardiac lesions exhibiting normal enteral feeding tolerance while awaiting surgical repair. Enteral feeding was well-tolerated independent of cardiac malformation or ductal-flow pattern and did not appear to be affected by the use of umbilical venous or arterial catheters. As this is a small retrospective review, conclusions regarding the safety of enteral feeding in PGE1-dependent neonates are speculative at this time. However, we believe this study points towards safely providing improved nutrition in this population through early initiation of enteral feeding. Further investigation of this practice is currently underway in our institution to more fully define the risks and benefits of enteral feeding in this unique population.